Kidney failure affects a significant part of the world's population where more than 2 million people currently undergoing some sort of treatment for end-stage kidney disease (ESKD). One of the most common treatments is hemodialysis (HD) which consists of an extracorporeal membrane-based therapy that can retain toxins and remove excess fluid. However, patients can experience short- and long-term life-threatening complications associated with protein adsorption to the HD membrane. Upon contact between blood and membrane, protein adsorption takes place incautiously promoting the build-up of a cake layer and activation of complex reactions called biochemical cascades. The mechanisms of protein adsorption can be complex due to the highly heterogeneous composition of blood and are still not fully understood. Membrane properties such as biocompatibility and surface roughness play a critical role in protein adsorption since it influences the affinity between membrane material and blood components. Also, the HD operating conditions in the clinical practices can significantly influence protein adsorption and play a critical role in the cell rupture pathway which can enhance the adsorption process. Modeling and predicting membrane fouling and protein adsorption in HD have a great potential to guide the definition of adequate operating conditions for HD treatment but still limited. Predictive models can indicate how to manipulate blood and dialysate flow rate, operating pressure, and treatment time to yield better control of protein adsorption, reducing the side effects that are linked to unacceptably high morbidity and mortality rates. This critical review will focus on a comprehensive understanding of the protein adsorption phenomenon, including its mechanisms, its influential factors, and the blood activations and the consequences associated with this phenomenon. Also, and current models and challenges for predicting protein adsorption and membrane fouling are reviewed. Moreover, this review will cover how there is a distinct lack of knowledge when it comes to currently hypothesized mechanistic aspects and their translation into mathematical concepts and models to predict protein adsorption and hemodialysis membrane performance. The models seen so far lack in describing multiprotein adsorption as a function of hemodialysis operating conditions and correlation with patient outcomes.

肾功能衰竭影响世界上很大一部分人口，目前有超过200万人接受终末期肾脏疾病（ESKD）的某种治疗。最常见的治疗方法之一是血液透析（HD），它是一种基于体外膜的疗法，可以保留毒素并去除多余的液体。然而，患者可能会经历短期和长期危及生命的并发症，这些并发症与蛋白质吸附至HD膜有关。在血液和膜之间接触时，蛋白质吸附会不适当地促进结块层的堆积并激活称为生化级联反应的复杂反应。由于血液的高度异质组成，蛋白质吸附的机制可能很复杂，并且仍不完全清楚。诸如生物相容性和表面粗糙度之类的膜特性在蛋白质吸附中起着至关重要的作用，因为它会影响膜材料与血液成分之间的亲和力。同样，在临床实践中，HD操作条件会显着影响蛋白质的吸附，并在细胞破裂途径中起关键作用，从而增强吸附过程。对HD中的膜污染和蛋白质吸附进行建模和预测具有巨大的潜力，可以指导HD处理的适当操作条件的定义，但仍然受到限制。预测模型可以指示如何控制血液和透析液的流速，工作压力和治疗时间，以更好地控制蛋白质的吸附，从而减少与高发病率和高死亡率有关的副作用。这篇重要的评论将集中于对蛋白质吸附现象的全面理解，包括其机理，影响因素，血液活化以及与该现象相关的后果。另外，综述了预测蛋白质吸附和膜污染的当前模型和挑战。此外，本篇综述将涵盖当涉及当前假设的机械方面以及如何将其转化为数学概念和模型以预测蛋白质吸附和血液透析膜性能时，如何明显缺乏知识。迄今为止，这些模型缺乏描述多蛋白吸附与血液透析操作条件以及患者预后的关系的功能。包括其机制，影响因素，血液活化以及与此现象相关的后果。另外，综述了预测蛋白质吸附和膜污染的当前模型和挑战。此外，本篇综述将涵盖当涉及当前假设的机械方面以及如何将其转化为数学概念和模型以预测蛋白质吸附和血液透析膜性能时，如何明显缺乏知识。迄今为止，这些模型缺乏描述多蛋白吸附与血液透析操作条件以及患者预后的关系的功能。包括其机制，影响因素，血液活化以及与此现象相关的后果。另外，综述了预测蛋白质吸附和膜污染的当前模型和挑战。此外，本篇综述将涵盖当涉及当前假设的机械方面以及如何将其转化为数学概念和模型以预测蛋白质吸附和血液透析膜性能时，如何明显缺乏知识。迄今为止，这些模型缺乏描述多蛋白吸附与血液透析操作条件以及患者预后的关系的功能。并综述了目前预测蛋白质吸附和膜污染的模型和挑战。而且，本篇综述将涵盖当涉及当前假设的机械方面以及如何将其转化为数学概念和模型以预测蛋白质吸附和血液透析膜性能时，如何明显缺乏知识。迄今为止，这些模型缺乏描述多蛋白吸附与血液透析操作条件以及患者预后的关系的功能。并综述了目前预测蛋白质吸附和膜污染的模型和挑战。而且，本篇综述将涵盖当涉及当前假设的机械方面以及如何将其转化为数学概念和模型以预测蛋白质吸附和血液透析膜性能时，如何明显缺乏知识。迄今为止，这些模型缺乏描述多蛋白吸附与血液透析操作条件以及患者预后的关系的功能。