Optimizing the Priming Process for Hemoadsorption Combined with Hemodialysis (HAHD): A Two-Stage In Vitro and Clinical Validation Study

Introduction: Conventional priming for Hemoadsorption Combined with Hemodialysis (HAHD) is complex, time-consuming, and resource-intensive. We aimed to develop and validate a standardized, efficient, and safe tandem priming protocol by systematically evaluating its operational efficiency, circuit cleanliness, clinical efficacy and clinical safety. Methods: A two-stage "in vitro screening–clinical validation" design was utilized, using the HA130 hemoadsorption cartridge (Jafron, China) throughout all experiments and clinical sessions. The in vitro phase compared four novel tandem priming methods (varying slow-prime flow rates and fast-flush volumes) against a traditional separate-priming method to identify an optimal protocol based on efficiency and cleanliness. This protocol was then validated in a single-center, single-blind randomized controlled trial involving 53 maintenance hemodialysis patients randomized to the optimized tandem method (n = 29) or the traditional method (n = 24). The primary safety outcome was circuit clotting; the primary efficacy outcome was in solute clearance. Results: In vitro, all tandem methods were significantly faster (26.05–34.89 min vs. 55.40 min, P < 0.001) and consumed fewer resources while meeting all cleanliness standards. After preliminary safety screening excluded a faster flow rate (100 mL/min), the 50 mL/min slow-prime with 2000 mL fast-flush protocol was selected. In the clinical trial, the incidence of Grade I cartridge clotting was low and statistically comparable between the tandem (3.45%) and traditional (4.17%) groups (P > 0.05). Solute reduction values for urea, creatinine, and β2-microglobulin were not significantly different, demonstrating comparable therapeutic efficacy. Conclusion: The novel tandem priming protocol is a highly efficient, resource-sparing, and safe alternative to traditional methods. It maintains therapeutic efficacy and circuit patency, offering a valuable, standardized solution for clinical practice.