Effects of hollow fiber packing density and housing shape on the albumin filtration performance of CRRT filters

Abstract

Continuous renal replacement therapy (CRRT) has become the most commonly used acute blood purification therapy for critically ill patients. As a key point of extracorporeal blood circulation, the CRRT filter plays a decisive role in therapeutic efficacy. However, few in vitro studies have been conducted on CRRT filters, particularly concerning the effects of design factors on filter effectiveness and safety profile; no comprehensive evaluation system has been established. Here, we designed nine CRRT filters with various combinations of hollow fiber packing density (PD) and housing shape (effective hollow fiber length (L) and inner housing diameter (D) ratio (L/D ratio)) and introduced a high-frequency sampling pressure monitor to accurately monitor small changes in transmembrane pressure (TMP) and ultrafiltration rate (UFR) over time. We also used concentration polarization mass transfer resistance (R_c), change in sieving coefficient (S) of albumin over time, and amount of albumin removed (M_fld) to investigate the effects of two design factors on albumin filtration performance and analyze the mechanism of protein filtration performance over time, thereby establishing a comprehensive in vitro evaluation system to explore the safety profile of CRRT filters. Our results showed that the nine CRRT filters designed with different combinations of PD (50%, 55%, and 60%) and L/D ratio (2.9, 5.3, and 9.3) were able to maintain stability in terms of hemodynamics and water permeability; the lowest M_fld was PD = 60% and L/D ratio = 9.3, which indicates that design factor optimization can effectively control albumin filtration, thereby improving the safety profile of CRRT filters.