Effects of the Combination Therapy of Hemodialysis with Hemoperfusion on Medium Molecular Toxins and Protein Bound Uremic Toxins in Maintenance Hemodialysis Patients

INTRODUCTION: Protein-bound uremic toxins (PBUTs) and medium molecular toxins are incompletely removed by conventional hemodialysis (HD) and are associated with cardiovascular morbidity and mortality in maintenance hemodialysis (MHD) patients. This study aimed to observe the reduction ratios 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 2 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 ± 5.61-21.50 ± 6.69 μg/mL, t = 5.882, p < 0.001; median reduction ratio 30.48%), IS (from 14.04 ± 1.70-11.70 ± 1.12 μg/mL, t = 7.199, p < 0.001; median reduction ratio 14.61%), and PCS (from 8.09 ± 1.58-6.63 ± 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 3 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.