Identification of plasma proteins adsorbed to hemodialyzers during clinical use.

An investigation has been made of the protein layers formed on hemodialysis membranes during clinical use. Dialyzers having membranes of polymethylmethacrylate (PMMA), Cuprophane, cellulose acetate (CA), and saponified cellulose ester (SCE) were examined. Immediately following dialysis the dialyzers were washed free of blood and the membranes eluted with 2% SDS. The eluates were examined by SDS-PAGE followed by protein immunoblotting. Antisera to 16 common plasma proteins were used to probe for the presence of these proteins in the eluates. Most of the proteins tested for were found in the different eluates, suggesting that the protein layers are extremely complex. The protein compositions were qualitatively different on the different membranes. Except for HMWK the contact phase clotting factors were present in very small amounts and were largely activated. The clear presence of HMWK and the relatively small amounts of fibrinogen provide support for the occurrence of the Vroman effect. Fibrinogen was found to be degraded and this may be related to the observation that plasminogen was activated to plasmin. Complement C3 was an abundant component of all eluates. It was degraded to small fragments in a way which could not be related to complement activation. Many of the other proteins, particularly those of high molecular weight, were extensively degraded. It is speculated that this heretofore unremarked phenomenon may be due to the action of enzymes released by cell damage.