Rhein-modified hemodialysis membranes suppress red blood cell fatigue and thrombosis.

Dialysis membrane-related hemolysis (DMH) is an important factor influencing blood purification efficacy in critically ill patients. However, the pre-hemolysis fatigue process of RBCs and whether RBC fatigue can induce thrombus formation remains largely unexplored. In this study, rhein-modified polysulfone (PSf) hemodialysis membranes (RH membranes) were fabricated, and their impact on RBC fatigue and thrombus formation was investigated. In this study, the RH membranes demonstrated potent physicochemical properties and hemodialysis performance, effectively inhibiting RBC fatigue and RMPs formation, and alleviating hemoglobin (Hb)-mediated sublethal damage. Furthermore, we showed that RH membranes exhibited antithrombotic efficacy by diminishing RMPs formation and subsequently inhibiting activation of predominant coagulation pathways and key coagulation factors. In the murine model of acute hemolysis, the RH membranes mitigated DMH in vivo and provided anticoagulation and organ-protective effects. In conclusion, RH membranes are a promising option for hemodialysis treatment in critically ill patients.