HA130/KHA80 hemoperfusion combined with hemodialysis was associated with a lower risk of all-cause mortality compared with hemodialysis alone (HR 0.69).
Cohort (n=640)
No
Does adjunctive hemoperfusion combined with conventional hemodialysis reduce all-cause mortality in patients receiving maintenance hemodialysis?
In patients receiving maintenance hemodialysis, the addition of hemoperfusion to conventional hemodialysis was associated with a significant reduction in all-cause and cardiovascular mortality.
Hazard Ratio: 0.69 (95% CI 0.52–0.9)
p-value: p=0.009
Patients receiving maintenance hemodialysis (MHD) experience a high mortality burden, with cardiovascular disease remaining a major cause of death. This study aimed to evaluate the association between adjunctive hemoperfusion combined with conventional hemodialysis (HD + HP) and long-term survival outcomes in patients receiving MHD. This single-center retrospective cohort study was conducted at Shanghai Changhai Hospital. Patients with end-stage renal disease who received MHD between January 2015 and December 2023 were retrospectively identified from the center’s hemodialysis records. Among the 640 eligible patients, 419 (65.5%) received HD during the study period, whereas 221 (34.5%) received adjunctive HP in addition to HD. HP exposure was modeled as a time-varying covariate in a multivariable time-dependent Cox proportional hazards model to account for treatment timing. A marginal structural model (MSM) using stabilized inverse probability of treatment weighting was further constructed to address measured time-dependent confounding. Propensity score matching was performed as a sensitivity analysis using 1:1 nearest-neighbor matching without replacement, with a caliper width of 0.02. Survival outcomes in the matched cohort were evaluated using Simon–Makuch curves and Mantel–Byar tests. Among the 640 included MHD patients, the median age was 67.5 years, 66.9% were male, and the median dialysis vintage was 48.0 months. During follow-up, 348 patients died, corresponding to all-cause mortality proportion of 54.4% in the study sample. Diabetic kidney disease was the most common primary renal disease (30.9%), followed by chronic glomerulonephritis (29.4%) and hypertensive nephropathy (18.6%). Among the 348 deaths, cardiovascular disease was the leading cause of death (32.8%), followed by multiple organ dysfunction syndrome (21.6%). In both the multivariable time-dependent Cox model and the MSM, HD + HP was consistently associated with a lower risk of all-cause mortality compared with HD, with HRs of 0.69 (95% CI, 0.52–0.90; P = 0.009) and 0.73 (95% CI, 0.55–0.97; P = 0.030), respectively. After 1:1 propensity score matching, 173 patients remained in each group with improved baseline balance. In the propensity score-matched cohort, Simon-Makuch analyses further supported a protective association of HD + HP with all-cause and cardiovascular mortality compared with HD (Mantel-Byar test, P = 0.032 and P = 0.003, respectively). In this single-center retrospective cohort of patients receiving MHD, cardiovascular disease was the leading cause of death. HD + HP therapy was associated with lower all-cause mortality in time-dependent Cox regression and MSM-based weighted analyses, and with lower all-cause and cardiovascular mortality in propensity score-matched Simon–Makuch analyses. These findings suggest a potential survival benefit of adjunctive HP.
Y et al. (Mon,) conducted a cohort in End-stage renal disease receiving maintenance hemodialysis (n=640). HA130/KHA80 hemoperfusion combined with hemodialysis vs. Conventional hemodialysis alone was evaluated on All-cause mortality (HR 0.69, 95% CI 0.52-0.90, p=0.009). HA130/KHA80 hemoperfusion combined with hemodialysis was associated with a lower risk of all-cause mortality compared with hemodialysis alone (HR 0.69).