Comparative efficacy between hemodialysis using super high‐flux dialyzer with hemoperfusion and high‐volume postdilution online hemodiafiltration in removing protein bound and middle molecule uremic toxins: A cross‐over randomized controlled trial

Comparative efficacy between hemodialysis using super high‐flux dialyzer with hemoperfusion and high‐volume postdilution online hemodiafiltration in removing protein bound and middle molecule uremic toxins: A cross‐over randomized controlled trial

Background Hemodialysis (HD) using super high‐flux dialyzer (HD + SHF) comparably removed uremic toxins to high‐volume postdilution online hemodiafiltration (olHDF). Integration of hemoperfusion (HP) to HD + SHF (HD + SHF + HP) might provide superior uremic toxin removing capability to high‐volume p...

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Published in:Artificial organs Vol. 46; no. 5; pp. 775 - 785
Main Authors: Tiranathanagul, Khajohn, Khemnark, Nutchaya, Takkavatakarn, Kullaya, Limjariyakul, Maneerut, Mahatanan, Nunta, Chariyavilaskul, Pajaree, Wittayalertpanya, Supreecha, Susantitaphong, Paweena, Eiam‐Ong, Somchai
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 01-05-2022
Subjects:
Albumin
Blood flow
Dialyzers
Flow velocity
Hemodiafiltration - adverse effects
Hemodialysis
Hemoperfusion
high‐volume postdilution online hemodiafiltration
Humans
Kidney Failure, Chronic - therapy
Patients
Reduction
Renal Dialysis - adverse effects
Serum albumin
super high‐flux dialyzer
Superhigh frequencies
Toxins
Urea
Ureas
Uremic Toxins
hemodialysis
hemoperfusion
super high-flux dialyzer
high-volume postdilution online hemodiafiltration
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Summary:Background Hemodialysis (HD) using super high‐flux dialyzer (HD + SHF) comparably removed uremic toxins to high‐volume postdilution online hemodiafiltration (olHDF). Integration of hemoperfusion (HP) to HD + SHF (HD + SHF + HP) might provide superior uremic toxin removing capability to high‐volume postdilution olHDF. Method The present study was conducted in thrice‐a‐week HD patients to compare the efficacy in removing indoxyl sulfate (IS), beta‐2 microglobulin (β2M), and urea between high‐volume postdilution ol‐HDF and HD + SHF + HP, comprising HD + SHF as the main treatment plus HD + SHF + HP 1/week in the first 4 weeks and 1/2 weeks in the second 4 weeks. Results Ten prevalent HD patients with blood flow rate (BFR) above 400 ml/min were randomized into two sequences of 8‐week treatment periods of HD + SHF + HP and later high‐volume postdilution olHDF or vice versa. When compared with high‐volume postdilution olHDF (convective volume of 26.02 ± 1.8 L/session), HD + SHF + HP provided comparable values of percentage reduction ratio of IS (52.0 ± 11.7 vs. 56.3 ± 7.5%, p = 0.14) and β2M (83.7 ± 4.9 vs. 84.0 ± 4.3%, p = 0.37) and slightly lower urea reduction ratio. Despite greater dialysate albumin loss (p = 0.008), there was no significant change in serum albumin level in HD + SHF + HP group. Conclusions HD + SHF + HP could not provide superior efficacy in removing uremic toxins to high‐volume postdilution olHDF. The use of low BFR of 200 ml/min during the first 2 h of HD + SHF + HP session, according to the instruction of manufacturer, might impair the efficacy of the HD + SHF part in removing uremic toxins. HD + SHF + HP provided comparable efficacy in removing uremic toxins when compared with high‐volume postdilution olHDF. HD + SHF + HP could have important role in the community that HDF is not available or in HD patients with limited BFR that could not achieve high volume of convection in HDF.
Bibliography:Funding information
This study was supported by a grant from the Kidney Foundation of Thailand
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ISSN:0160-564X
1525-1594
DOI:10.1111/aor.14161