Latest advances in zwitterionic structures modified dialysis membranes

End-stage renal diseases are affecting many patients and as a result, demand to receive dialysis service is growing annually. Morbidity and mortality rates are reported to be higher in comparison with healthy humans. The reason is reported to be the hemoincompatiblity of blood purification membranes, which hinders patients’ lives. Activation of different immune systems in the body, in case of blood-membrane interaction, results in several side effects, of which cardiovascular shocks have been mentioned to be a major one. Efforts to solve this issue have resulted in different generations of dialysis membranes. Zwitterionic immobilized membranes are the latest (third) generation, which owns a higher degree of hemocompatiblity with more stability of immobilized structures. This critical review intends to cover recent efforts conducted over the zwitterionization of polymeric membrane surfaces with the goal of improving hemocompatibility. Different aspects of third-generation membranes are discussed for a better understanding of the current gap and gathering the knowledge to further develop the field. Accordingly, this critical survey provides an in-depth understanding of blood purification membranes zwitterionization for paving the way for the optimum enhancement of hemodialysis membrane hemocompatibility. Polymeric hollow fibers cross-section for hemodialysis; (a) with the modified surface structure using zwitterionic materials resulting in low blood cascade activation and minimized clotting, (b) untreated inner surface with blood protein attachment, cascade activation, and clotting. • Three generations of hemodialysis membranes were reviewed. • Influence of zwitterionic-immobilized polymeric membranes on hemocomptability. • Immobilization techniques of zwitterionization and its influences on hemocomptability. • Critical assessments of hemocomptability of various zwitterionic membranes. • Key findings of fibrinogen and proteins adsorption.