# Comparing Clearances of Polymethylmethacrylate and Polysulfone Dialyzer Membranes for Postdilution Hemodiafiltration in Patients With Kidney Failure: Protocol for a Systematic Review and Meta-Analysis

## TL;DR

This study will compare the effectiveness of two dialyzer membranes in hemodiafiltration for kidney failure patients to determine which better clears waste.

## Contribution

The study introduces the first systematic review and meta-analysis comparing PMMA and PS membranes in postdilution HDF.

## Key findings

- PMMA membranes may offer comparable convective capacity with reduced albumin loss compared to PS membranes.
- No prior systematic reviews have compared the efficacy of PMMA and PS membranes in HDF.
- Improved solute clearance could benefit patients undergoing long-term hemodialysis.

## Abstract

Kidney replacement therapy (KRT) is needed by patients with kidney failure to eliminate metabolic waste. When kidney transplantation is not feasible, hemodialysis (HD) is performed. Hemodiafiltration (HDF) provides a better solute clearance than conventional HD due to its higher convective dose. The clearance performances of HDF also depend on the type of dialysis membrane used. Polysulfone (PS) membranes have been used since 1965 due to their excellent resistance and biocompatibility. However, the newer generation of polymethylmethacrylate (PMMA) membranes offers comparable convective capacity with reduced albumin loss.

The forthcoming study aims to compare the solute clearance of postdilution HDF using PMMA versus PS dialyzer membranes in patients with kidney failure requiring long-term HD.

The literature search will use databases including PubMed, Scopus, Web of Science, Embase, and Cochrane. Two independent reviewers will select studies and assess their quality. Pooled estimates of relevant factors will be computed via a random-effects model using Stata/BE 18 (StataCorp) software. The reporting of findings will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

The search and screening for the systematic literature review are expected to be completed in May 2026. Data extraction, quality appraisal, and subsequent data synthesis will begin in June 2026. The review should be completed by October 2026, and the study results will be published in 2027.

Dialyzer membrane clearance determines HD quality. Nevertheless, many middle uremic molecules are poorly cleared with conventional HD. Consequently, HDF was invented to improve their clearance. Among the most widely used dialyzer membranes, PS and PMMA are used in the newer generation of HDF. Nevertheless, no available systematic reviews have compared the efficacy of the 2 dialyzer membrane materials. Although no ideal dialyzer can efficiently remove all types of uremic toxins while retaining essential elements, improving solute clearance should benefit patients. This information could help clinicians determine which membrane to use in HDF.

PROSPERO CRD42024603277; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024603277

PRR1-10.2196/71943