High permeability of dialysis membranes: what is the limit of albumin loss?

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Abstract
The enhanced removal of an extended spectrum of toxic low molecular weight proteins is regarded as a contribution to the improvement of dialysis adequacy. Apart from costly convective treatment modalities like haemofiltration and haemodiafiltration, the application of high‐flux haemodialysis permits the elimination of far larger uraemic toxins than those removable by conventional low‐flux dialysis. As a consequence, increasingly permeable high‐flux dialysis membranes with excellent blood purification characteristics have been developed during the last decade, contributing to clinical benefits such as an improved erythropoietin responsiveness in renal anaemia [1,2]. However, the membrane pore size can be enlarged only within restricted limits, since together with the removal of high molecular weight toxins such as, for instance, erythropoietic inhibitors [3], essential large proteins such as albumin get lost, eventually resulting in a deficiency state.