Biokompatibilitätsprobleme bei der Hämodialyse

Zusammenfassung

Seit erstmals Interaktionen von Blut und körperfremden Materialien bei der chronischen Hämodialysebehandlung beobachtet wurden, folgten zahlreiche Untersuchungen, um das Phänomen der Biokompatibilität zu ergründen. Dies hatte zur Folge, daß erhebliche Verbesserungen bei den Membranen, Schlauchsystemen, Geräten und der Behandlung selbst erzielt werden konnten. Im folgenden wird versucht, einen Überblick über die auslösenden Ursachen und die Phänomene, die durch die Interaktion von Blut mit körperfremden Oberflächen verursacht werden, aufzuzeigen.

Die Probleme, die bei der Entwicklung biokompatibler Membranen vorhanden sind, scheinen in naher Zukunft noch nicht alle lösbar zu sein. Unsere ganze Sorgfalt muß daher der Hämodialysebehandlung selbst und der Verringerung ihrer möglichen Nebenwirkungen, die z.B. durch Reste von Sterilisationsmitteln, endotoxinhaltige Dialysierflüssigkeiten hervorgerufen werden können, gelten. Besonders im Hinblick darauf, daß die Zahl der Patienten, die Biomaterialien benötigen, rasch zunimmt und diese Patienten länger leben, wodurch sie den Gefahren durch die Biounverträglichkeit der Materialien länger ausgesetzt werden, sind wir alle aufgefordert, unseren Patienten eine risikoarme Hämodialyse zu ermöglichen served in the treatment of chronic hemodialysis, numerous investigations were performed to definite the phenomena of biocompatibility. As a consequence, considerable improvements in membranes, tube systems, equipments and in the treatment itself have been accomplished. The following is an attempt to demonstrate the initiating causes and the phenomena which results from the interaction of blood with artificial surfaces.

The problems being encountered in the development of biocompatible membranes are not likely to all be solved in the near future. We must, therefore, concentrate all our efforts on the hemodialysis treatment itself and on the reduction of its possible side-effects which can, for example, be caused by the remnants of sterilizing agents, dialysis fluid containing endotoxin, etc. Especially in view of the fact that the number of patients requiring biomaterials is rapidly increasing and that these patients are living longer, whereby they are exposed to the dangers of bioincompatibility of the materials for a longer period of time, we are all called upon to provide low-risk hemodialysis for our patients.

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