Effects of the combination therapy of hemodialysis with hemoperfusion on medium molecular toxins and protein bound uremic toxins in maintenance hemodialysis patients

Introduction:This study aimed to observe the reduction rations of the combination therapy of HD with hemoperfusion(HP) on medium molecular toxins and PBUTs in MHD patients. Methods: In this single-center observational study, 38 MHD patients were treated with HD plus HP using the Jafron KHA130 cartridge for 12 weeks. Serum concentrations of β2-microglobulin (β2-MG), indoxyl sulfate (IS), and p-cresyl sulfate (PCS) were measured by Enzyme-Linked Immunosorbent Assay (ELISA) at baseline and after 12 weeks, and their reduction rates were calculated. Patients were stratified by the number of HP sessions received during the study period: Group A (>4 times/12 weeks, n=16) and Group B (≤4 times/12 weeks, n=22). The reduction ratio of blood β2-MG and PBUTs(PCS, IS) from baseline were compared between the two groups of patients at 12 weeks. Results: After the 12-week study period, significant reductions were observed in serum levels of β2-MG (from 29.72±5.61 to 21.50±6.69 μg/ml, t=5.882, P<0.001; median reduction ratio 30.48%), IS (from 14.04±1.70 to 11.70±1.12 μg/ml, t=7.199, P<0.001; median reduction ratio 14.61%), and PCS (from 8.09±1.58 to 6.63±1.33 μg/ml, t=4.984, P<0.001; median reduction ratio 17.10%). There was no statistically significant difference in the reduction ratio of β2-MG, PCS and IS between Group A and Group B (P>0.05). The treatment was well tolerated, with only three episodes of hypotension that resolved with conservative management. Conclusion: Combined HD and HP therapy was associated with lower serum levels of β2-MG, IS, and PCS in MHD patients, suggesting this modality may represent a viable strategy for achieving reductions in PBUT and medium molecular toxin levels. The relationship between HP session frequency and toxin reduction requires further investigation in adequately powered randomized controlled trials.