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

Tiranathanagul, Khajohn; Khemnark, Nutchaya; Takkavatakarn, Kullaya; Limjariyakul, Maneerut; Mahatanan, Nunta; Chariyavilaskul, Pajaree; Wittayalertpanya, Supreecha; Susantitaphong, Paweena; Eiam‐Ong, Somchai

doi:10.1111/aor.14161

Cited by 8 publications

(4 citation statements)

References 38 publications

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“…Therefore, clinical treatment strategies are optimized by combining HP with HD [23]. Tiranathanagul K, et al had Compared the effects of high-flux dialyzer with 2 hours of hemofusion and high volume post-dilution online hemodiafiltration on uremic toxin clearance, it was found that HD+HP was not superior to HDF [24].Here, the study found the high flux dialysis combined with hemoperfusion (HP cartridge containing 160 ml resin; OCI Medical Devices Co., Ltd, Chengdu, China) that the clearance of Indoxyl sulfate was higher than high flux dialysis and hemodiafiltration (41.53%, 17.19%, 22.79%), and 4 hours was better than 2 hours (45.53%, 26.94%). However, the clearance of small molecular and water soluble uremic toxins is not superior to high flux dialysis and hemodiafiltration.…”

Section: Discussionmentioning

confidence: 99%

The Effect of High-Flux Dialysis Combined with Hemoperfusion to Eliminate Indoxyl Sulfate in Dialysis Patients

2024

J Urol Ren Dis

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Indoxyl sulfate is a protein binding urotoxin, which is discharged by the kidney through secreted in proximal tubule and accumulates in patients with renal failure, It can cause the endothelial dysfunction and cardiovascular disease. Due to has a high affinity for albumin, cannot effectively remove by hemodialysis and hemodiafiltration. Therefore, protein-bound urinary toxins have become a focus of renal replacement treatment.We used high flux dialysis combined with hemoperfusion for treatment, and found that the clearance of indoxyl sulfate was higher than high flux dialysis and hemodiafiltration, and 4 hours was better than 2 hours.

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Section: Discussionmentioning

confidence: 99%

The Effect of High-Flux Dialysis Combined with Hemoperfusion to Eliminate Indoxyl Sulfate in Dialysis Patients

2024

J Urol Ren Dis

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“…From our point of view, possible reasons included the following: (1) HFHD+HDF better cleared some unknown medium and large molecule uraemic solutes/toxins, which are associated with anemia and may inhibit erythropoiesis or cause erythropoietin resistance 28 . The toxins that may be eliminated by HFHD + HDF include β2M and the urea reduction ratio 29 (2) Since patients treated with HFHD + HDF have a higher quality of life, they may have an improvement in anorexia and therefore may have a better nutritional intake, resulting in improved erythrocyte production. This is a presumed indirect effect.…”

Section: Discussionmentioning

confidence: 99%

Middle‐size molecule clearance as measured by β2‐microglobulin in high‐flux versus low‐flux dialysis and hemodiafiltration: A prospective randomized controlled trial

Yang

Chen

et al. 2022

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Background Whereas most studies to date have mainly concentrated on the comparison between high‐flux hemodialysis (HFHD) and hemodiafiltration (HDF), or HFHD and low‐flux hemodialysis (LFHD) in relation to the clearance of β2‐microglobulin (β2M) in HD patients, there have been few related to combined HFHD and HDF therapy. To compare the clearance of middle‐sized molecules as measured by β2M in HFHD versus LFHD and HDF. Methods A prospective, single‐center, open‐label, observer‐blinded, randomized controlled trial was conducted at the West China Hospital of Sichuan University in China. Patients received either HFHD or LFHD and HDF 3 times a week with follow‐ups at one and 3 months. The primary endpoint was the clearance of β2M at 3 months. The secondary endpoints included hemodialysis‐related adverse events, changes in anemia, states of nutrition, and inflammatory indices. Results After 3 months of treatment, the HFHD+HDF group achieved a higher satisfaction level than the LFHD+HDF group, with decreased serum β2M concentrations (34.493 ± 7.257 vs. 43.593 ± 9.036 mg/L, p < 0.001) and elevated red blood cell counts (3.959 ± 0.742 vs. 3.602 ± 0.578 × 1012/L, p = 0.015). Compared with baseline, both kinds of treatment led to increases in serum urea (t = −3.623, p = 0.001 vs. t = −4.240, p < 0.001), cholesterol (t = −2.511, p = 0.016 vs. t = −4.472, p < 0.001), and magnesium (t = −2.648, p = 0.011 vs. t = −3.561, p = 0.001). An elevated level of serum albumin (t = −2.683, p = 0.010) was observed only in the HFHD+HDF group. Conclusions Combined therapy with HFHD and HDF has a beneficial effect on improving β2M clearance, red blood cell management, and nutrition status in HD patients.

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“…The HF membrane is the standard of care and would reflect the routine clinical practice in middle-and high-income countries [31]. Tiranathanagul et al [68] executed a study comparing HF hemodiafiltration versus MCO HD plus hemoadsorption with the HA130 cartridge (Jafron Biomedical, Zhuhai City, China), containing microspheres made of styrene-divinylbenzene. The study had a crossover design and randomized 10 patients previously on HF HD to carry out 6 sessions of either MCO HD or HF hemodiafiltration (phase 1), followed by a 2-week wash-out period in which patients returned to HF HD (phase 2).…”

Section: Adsorptionmentioning

confidence: 99%

Rationale for a New Classification of Solutes of Interest in Chronic Kidney Disease and Hemodialysis

et al. 2023

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A hallmark of chronic kidney disease is the retention of solutes that normally are eliminated by the kidneys. The current classification defines uremic toxins based on molecular weight and protein affinity. The retention of solutes is already detected in the early stages of the disease when patients are pauci-symptomatic or asymptomatic but the role of therapies to retard the loss of kidney function in patients with chronic kidney disease (e.g., modulators of the renin-angiotensin-aldosterone system, sodium-glucose cotransporter inhibitors) in reducing uremic toxins is poorly understood. Most of the research evaluating the impact of therapies to lower serum concentrations of those toxic compounds is carried out in patients with kidney failure already undergoing kidney replacement therapy. The removal of those molecules relies in physicochemical mass transfer phenomena, i.e., adsorption, diffusion, and convection. In the past 2 decades, the rise and broad adoption of blood purification strategies with enhanced convective properties, such as high-volume online hemodiafiltration and expanded hemodialysis, considerably amplified the ability to mechanically extract middle molecules (molecular weight >0.5 kDa) from the blood compartment. Nonetheless, the classification of uremic toxins has not evolved in parallel with dialysis advancements. Mounting evidence demonstrates the link between middle molecules with uremic symptoms, cardiovascular and mortality risks. An urgent need for updating the classification exists. Defining the causative relationship between specific solutes and specific clinical outcomes will promote the development of targeted therapies. In parallel, the inclusion of new pertinent dimensions to the classification like the influence of new dialysis membranes, sorbents, and intestinal chelators in the concentration of uremic toxins would improve the understanding of the pathogenesis of chronic kidney disease, setting the pace for future research in nephrology.

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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

Cited by 8 publications

References 38 publications

The Effect of High-Flux Dialysis Combined with Hemoperfusion to Eliminate Indoxyl Sulfate in Dialysis Patients

The Effect of High-Flux Dialysis Combined with Hemoperfusion to Eliminate Indoxyl Sulfate in Dialysis Patients

Middle‐size molecule clearance as measured by β2‐microglobulin in high‐flux versus low‐flux dialysis and hemodiafiltration: A prospective randomized controlled trial

Rationale for a New Classification of Solutes of Interest in Chronic Kidney Disease and Hemodialysis

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