Long-Term Safety of "4-Hour" Hemoadsorption Combined with Hemodialysis in Maintenance Hemodialysis Patients: A Multicenter Prospective Cohort Study.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2025-04-21 DOI:10.1159/000545988

Dongliang Zhang, Cuiping Liu, Tao Yang, Jingxin Zhao, Xiaofei Wang, Liping Zhang, Yuanyuan Li, Yangyang Shen, Yanjun Gao, Hongjuan Zhang

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Abstract

Introduction: Current guidelines recommend limiting hemoadsorption (HA) duration to 2 h during hemodialysis (HD) sessions due to theoretical concerns about adsorbent saturation and clotting risks. This multicenter prospective cohort study evaluated the long-term safety and efficacy of a novel "4Hs" protocol (4-h HA-HD with blood flow >250 mL/min).

Methods: 78 maintenance HD patients from four centers underwent 26 weeks of 4Hs therapy. Key outcomes included dialysis adequacy (spKt/V, urea reduction ratio [URR]), uremic toxin (UT) clearance (indoxyl sulfate [IS], p-cresyl sulfate, β2 microglobulin [B2MG]), clotting rates, and adverse events. Statistical comparisons were made against pre-study conventional HA+HD (2-h HA) data using paired t-tests and repeated-measures ANOVA.

Results: The 4Hs protocol demonstrated non-inferior safety to conventional HA+HD, with comparable clotting rates (1.79% vs. 1.62%, p = 0.665) and no significant differences in anemia markers or hypoalbuminemia. Dialysis efficacy improved significantly: spKt/V increased by 0.28 (p = 0.012), URR by 1.18% (p = 0.003), and UT reduction rates (IS: 56.17% vs. 40.14%, p < 0.001; pCS: 47.39% vs. 35.91%, p < 0.001; B2MG: 55.82% vs. 48.41%, p < 0.001). Albumin loss remained comparable between protocols (Δ 0.5 g/L, p > 0.05).

Conclusion: Extending HA duration to 4 h with high-flow hemodynamics (Qb >250 mL/min) is safe and enhances toxin clearance without increasing clotting risks. These findings challenge current SOP limitations on HA duration and support protocol optimization in maintenance HD patients.

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维持性血液透析患者“4小时”血液吸附联合血液透析（HAHD）的长期安全性：一项多中心前瞻性队列研究

目前的指南建议在血液透析（HD）期间限制血液吸附（HA）持续时间为2小时，因为理论上考虑吸附剂饱和和凝血风险。这项多中心前瞻性队列研究评估了一种新型“4Hs”方案的长期安全性和有效性（4小时HA-HD，血流量>250 mL/min）。方法：来自4个中心的78名维持性HD患者接受了26周的4Hs治疗。主要结局包括透析充分性（spKt/V、尿素还原比[URR]）、尿毒症毒素（UT）清除率（硫酸吲哚酚[IS]、硫酸对甲酚[pCS]、β2-微球蛋白[B2MG]）、凝血率和不良事件（AEs）。采用配对t检验和重复测量方差分析对研究前常规HA+HD（2小时HA）数据进行统计比较。结果：4Hs方案的安全性不逊于传统HA+HD，凝血率相当（1.79% vs. 1.62%, p=0.665），贫血标志物或低白蛋白血症无显著差异。透析疗效显著提高：spKt/V提高0.28 (p=0.012)， URR提高1.18% (p=0.003)， UT降低率（IS: 56.17% vs. 40.14%, p0.05）。结论：在高流量血流动力学（qb> 250 mL/min）下延长HA持续时间至4小时是安全的，并能增强毒素清除，而不增加凝血风险。这些发现挑战了目前SOP对维持性HD患者HA持续时间和支持方案优化的限制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.