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      Randomized Control Study on Hemoperfusion Combined with Hemodialysis versus Standard Hemodialysis: Effects on Middle-Molecular-Weight Toxins and Uremic Pruritus

      a , * , a , a , b , c , d , e , f , g , h , i , j , k , l , m , n , o , p , q , r , s , t , u , v , w , x , y , z , A , B , C , D , E , F , G , H , I , J , K , a , a , a
      Blood Purification
      S. Karger AG
      Hemoperfusion, Hemodialysis, Uremic toxins, Uremic pruritus, Adsorption

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          Introduction: Classic hemodialysis schedules present inadequate middle-molecular-weight toxin clearance due to limitations of membrane-based separation processes. Accumulation of uremic retention solutes may result in specific symptoms (e.g., pruritus) and may affect clinical outcome and patient’s quality of life. Hemoperfusion (HP) is a blood purification modality based on adsorption that can overcome such limitations, and thus, it may be interesting to test the efficacy of at least one session per week of HP combined with hemodialysis. This is a randomized, open-label trial, controlled, multicenter clinical study to investigate the effect of long-term HP combined with hemodialysis on middle-molecular-weight toxins and uremic pruritus in maintenance hemodialysis (MHD) patients. Methods: 438 MHD patients from 37 HD centers in China with end-stage kidney disease (63.9% males, mean age 51 years) suffering from chronic intractable pruritus were enrolled in the study. Eligible patients were randomized into four groups: low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), HP + LFHD, and HP + HFHD at a 1:1:1:1 ratio. Beta-2 microglobulin (β2M) and parathyroid hormone (PTH) were measured at baseline, 3–6, and 12 months. At the same time points, the pruritus score was evaluated. The primary outcome was the reduction of β2M and PTH, while the secondary outcome was the reduction of the pruritus score. Results: In the two groups HP + LFHD and HP + HFHD, there was a significant decrease of β2M and PTH levels after 12 months compared to the control groups. No significant differences were noted between HP + LFHD and HP + HFHD. Pruritus score reduction was 63% in the HP + LFHD group and 51% in the HP + HFHD group, respectively. Conclusion: The long-term HP + HD can reduce β2M and PTH levels and improve pruritus in MHD patients independently on the use of high- or low-flux dialyzers, showing that the results are linked to the effect of adsorption.

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          Author and article information

          Blood Purif
          Blood Purification
          S. Karger AG
          October 2022
          11 August 2022
          : 51
          : 10
          : 812-822
          [_a] aDepartment of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
          [_A] ADepartment of Nephrology, Aerospace Center Hospital, Beijing, China
          [_b] bBlood Purification Center, The Second Hospital of Tianjin Medical University, Tiangjing, China
          [_B] BDepartment of Nephrology, Shanghai Sixth People’s Hospital, Shanghai, China
          [_c] cBlood Purification Center, Northern Theater General Hospital, Shenyang, China
          [_C] CDepartment of Nephrology, Xinhua Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
          [_d] dDepartment of Nephrology, Daping Hospital of Army Medical University, Chongqing, China
          [_D] DDepartment of Nephrology, Qiandongnan People’s Hospital, Guizhou, China
          [_e] eBlood Purification Center, The First Affiliated Hospital of Henan University of Science and Technology, Henan, China
          [_E] EDepartment of Nephrology, Affiliated Hospital of Youjiang Ethnic Medical College, Guangxi, China
          [_f] fDepartment of Nephrology, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
          [_F] FDepartment of Nephrology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
          [_g] gDepartment of Nephrology, Beijing Friendship Hospital, Beijing, China
          [_G] GDepartment of Nephrology, Shanxi Provincial People’s Hospital, Taiyuan, China
          [_h] hDepartment of Nephrology, Guangdong Provincial People’s Hospital, Guangzhou, China
          [_H] HDepartment of Nephrology, Changsha Central Hospital, Changsha, China
          [_i] iDepartment of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
          [_I] IDepartment of Nephrology, Xijing Hospital of Air Force Medical University, Xi’an, China
          [_j] jDepartment of Nephrology, Heilongjiang Provincial People’s Hospital, Harbin, China
          [_J] JDepartment of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
          [_k] kDepartment of Nephrology, China-Japan Friendship Hospital, Beijing, China
          [_K] KDepartment of Nephrology, Joint Logistic Support Unit 940 Hospital, Gansu, China
          [_l] lDepartment of Nephrology, The First Affiliated Hospital of Baotou Medical College, Baotou, China
          [_m] mDepartment of Nephrology, The Second Affiliated Hospital of Lanzhou University, Lanzhou, China
          [_n] nDepartment of Nephrology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
          [_o] oDepartment of Nephrology, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
          [_p] pDepartment of Nephrology, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China
          [_q] qDepartment of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
          [_r] rDepartment of Nephrology, People’s Hospital of Wuhan University, Wuhan, China
          [_s] sDepartment of Nephrology, Jiangxi Provincial People’s Hospital, Nanchang, China
          [_t] tDepartment of Nephrology, Qinghai Provincial People’s Hospital, Xining, China
          [_u] uDepartment of Nephrology, Xinjiang Uygur Autonomous Region People’s Hospital, Urumqi, China
          [_v] vDepartment of Nephrology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
          [_w] wDepartment of Nephrology, The First Affiliated Hospital of Xinjiang Shihezi University, Xinjiang, China
          [_x] xDepartment of Nephrology, Affiliated Hospital of Guizhou Zunyi Medical College, Zunyi, China
          [_y] yDepartment of Nephrology, Dongguan People’s Hospital, Dongguan, China
          [_z] zBlood Purification Center, Hainan People’s Hospital, Hainan, China
          Author notes
          *Xuefeng Sun, xfssun@126.com, Xiangmei Chen, xmchen301@126.com
          Author information
          525225 Blood Purif 2022;51:812–822
          © 2022 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

          : 22 March 2022
          : 19 April 2022
          Page count
          Figures: 5, Tables: 4, Pages: 11
          This work was supported by the grants from the National Natural Science Foundation of China (32141005, 81830019, 82030025), National Key Technology R&D Program (2018YFA0108803). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.
          Focus ESKD – Research Article

          Cardiovascular Medicine,Nephrology
          Hemodialysis,Adsorption,Uremic pruritus,Uremic toxins,Hemoperfusion
          Cardiovascular Medicine, Nephrology
          Hemodialysis, Adsorption, Uremic pruritus, Uremic toxins, Hemoperfusion


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