Clinical Study on Four- versus Two-Hour Hemoadsorption Combined with Hemodialysis for Enhanced Clearance of Protein-Bound Uremic Toxins in Maintenance Hemodialysis Patients.

Abstract

Introduction: The optimal duration of hemoadsorption durations combined with hemodialysis (HAHD) for maintenance hemodialysis (MHD) patients remains unclear.

Methods: In this randomized controlled trial, we randomized 100 MHD patients to receive either 2-h HAHD group (HD + 2-h HP, n = 50) or 4-h HAHD group (HD + 4-h HP, n = 50) to compare treatment safety and efficacy profiles, with an additional 8 patients enrolled for hemoadsorber saturation assessment. This study received ethical approval from the Institutional Review Board (IRB No. [2024] No. 14).

Results: Results showed that both treatments significantly reduced serum levels of parathyroid hormone and β2-microglobulin, hippuric acid (HA), indole-3-acetic acid (IAA), p-cresyl sulphate (PCS), and kynurenine (KYN) (p < 0.05), with the 4-h HAHD group demonstrating greater clearance of indoxyl sulphate (IS) (p < 0.05) and significantly higher removal rates for HA, IAA, IS, PCS, and KYN compared to 2-h HAHD (p < 0.05). While protein-bound uremic toxins (PBUTs) clearance was similar at 2 h, the 4-h HAHD group achieved superior HA and IAA clearance by 4 h (p < 0.05). Both treatments were well tolerated, with no hematologic abnormalities and comparable adverse event rates.

Conclusion: These findings suggest that 4-h HAHD offers enhanced PBUTs clearance over 2-h HAHD while maintaining a favorable safety profile, supporting its clinical utility in MHD patients.