Long-term safety of '4-hour' hemoadsorption combined with hemodialysis (HAHD) in maintenance hemodialysis patients: A multicenter prospective cohort study.
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引用次数: 0
Abstract
Introduction: Current guidelines recommend limiting hemoadsorption (HA) duration to 2 hours 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-hour HA-HD with blood flow >250 mL/min).
Methods: Seventy-eight 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 [pCS], β2-microglobulin [B2MG]), clotting rates, and adverse events (AEs). Statistical comparisons were made against pre-study conventional HA+HD (2-hour 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; p-CS: 47.39% vs. 35.91%, p<0.001; B2MG: 55.82% vs. 48.41%, p<0.001). Albumin loss remained comparable between protocols (Δ0.5 g/L, p>0.05).
Conclusion: Extending HA duration to 4 hours 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.
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.