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

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.