The optimal timing of hemoperfusion component in combined hemodialysis–hemoperfusion treatment for uremic toxins removal

Abstract

The combination of hemodialysis-hemoperfusion (HDHP) has been proved to be superior to hemodialysis (HD) in eliminating uremic toxins. There are two methods of combination of HD and HP: the HP regime is utilized during the first two-hour an early HP conducted HDHP (EHDHP) or the last two-hour late HP conducted HDHP (LHDHP) of 4 h regular HD session. The present study was to compare these two methods in uremic toxins removal. Twenty adult chronic HD patients were enrolled in this self-control method study. The patients were randomized to receive one session of EHDHP or LHDHP. Two weeks later, the dialysis modalities were switched. The reduction ratio (RR) of targeted uremic toxins for each session was assessed. Both EHDHP and LHDHP showed a significant removal of small water-soluble solutes, middle-sized toxins and cytokines as well (p50.05). There were no significant differences between two methods in RR of small water-soluble solutes, like urea and creatinine. For middle-sized molecules and cytokines, such as PTH, b 2 -M, IL-1, IL-6, and TNF-a, the RR was markedly increased in LHDHP than that in EHDHP (p50.05). LHDHP showed no more intradialytic events than EHDHP. The combination of HD and HP in the last two hours in one hemodialysis session had more effect on eliminating middle-sized toxins and cytokines.

Changes of miR‑155 expression in serum of uremic patients before and after treatment and risk factors analysis

“…In this study, the levels of serum clinically related indicators and inflammatory factors in uremic patients before and after treatment were detected, and it was found that the β2-MG, Cr, BUN, PTH, CRP, and IL-6 levels after treatment were significantly lower than those prior to treatment. This showed that hemodialysis combined with hemoperfusion could effectively remove toxins and improve the inflammatory state of uremic patients, which was consistent with the results of previous studies (6,31,36); hemodialysis combined with hemoperfusion had a high value in treating uremia. The Pearson correlation coefficient analysis revealed that before treatment, serum miR-155 level was significantly positively correlated with clinically related indicators of β2-MG, Cr, BUN, and PTH (P<0.001), and it was significantly positively correlated with levels of CRP and IL-6 inflammatory factors (P<0.001).…”

“…If treatment is not timely, uremia caused by renal failure may aggravate the disease and eventually lead to death (3,4). At present, findings have shown that hemodialysis combined with hemoperfusion has a good effect on the treatment of uremia (5,6). Hemodialysis can remove blood urea nitrogen (BUN), creatinine (Cr) and bilirubin.…”

Effect of Hybrid Blood Purification Treatment on Secondary Hyperparathyroidism for Maintenance Hemodialysis Patients

“…This suggests that HD + HP treatment was better than HD treatment in the clearance of iPTH, β2-MG, and CysC. This is consistent with results of earlier literatures [16,25,27]. HP used the adsorption of activated carbon in the perfusion apparatus to remove iPTH, β2-MG, and CysC, and the combination of HP and HD can make up for the deficiency in removing macromolecular substances in HD alone.…”

“…HP used the adsorption of activated carbon in the perfusion apparatus to remove iPTH, β2-MG, and CysC, and the combination of HP and HD can make up for the deficiency in removing macromolecular substances in HD alone. Furthermore, this study revealed that moderate-and macro-molecular-weight toxins β2-MG and CysC could not be removed by HD treatment alone [16], and the concentrations of these 2 toxins in the HD group were higher after dialysis than before dialysis. The reason may be that ultrafiltration during HD caused loss of water, reduced blood volume, and concentrated blood, resulting in an increase in the concentrations of components that had not been removed in the process [28].…”

“…HD mainly removes small-molecular-weight toxins but has poor efficiency in removing moderate-and macro-molecularweight substances with a molecular weight greater than 500 Da [16]. PTH is a single-chain polypeptide that consists of 84 amino acids [5], has a molecular weight of 9,500 Da, is one of the moderate-molecular-weight toxins [16], and its effect on toxin removal in conventional HD is poor. HP non-specifically removes moderate-and macro-molecular-weight toxins, and toxins that bind with proteins through the adsorption of activated carbon.…”