Department of Basic Pathology, Universidade Federal do Paraná, Curitiba, Brazil.
School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
J Nephrol. 2022 Jun;35(5):1449-1456. doi: 10.1007/s40620-022-01283-3. Epub 2022 Mar 3.
Although high-volume online hemodiafiltration has been associated with higher clearance and lower pre-dialysis concentration of middle molecular weight toxins compared to hemodialysis, its effect on protein-bound uremic toxins has shown inconclusive results. In this study, we investigated whether hemodiafiltration impacts pre-dialysis plasma levels of the toxins indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid compared to high-flux hemodialysis.
This is a post-hoc analysis of the multicenter, randomized controlled trial HDFit (ClinicalTrials.gov: NCT02787161). Uremic toxins were determined by high performance liquid chromatography at baseline, 3, and 6 months. Mean differences in monthly changes of pre-dialysis uremic toxin concentrations between hemodiafiltration and high-flux hemodialysis were analyzed using linear mixed-effect models.
One hundred ninety-three patients (mean age 53 years old, 71% males) were analyzed. There were no differences between groups regarding clinical and biochemical characteristics at baseline or duration of dialysis session and blood flows throughout the follow-up. Mean differences in rates of change (μM/month, [confidence interval CI]) in high-flux hemodialysis vs. hemodiafiltration were 2.4 [0.3 to 4.56], 3.94 [- 1.54 to 9.41] and 0.06 [- 0.6 to 0.5] for indoxyl sulfate, p-cresyl sulfate and indole-3-acetic acid, respectively. In the exploratory analysis, these differences in high-flux hemodialysis vs. hemodiafiltration subgroup with convective volume > 27.5 L were 2.86 [0.43 to 5.28], 7.43 [0.7 to 14.16] and - 0.19 [- 0.88 to 0.50].
These exploratory findings suggest that hemodiafiltration is more effective in reducing indoxyl sulfate as compared to standard high-flux hemodialysis, and also that this effect was extended to p-cresyl sulfate in patients achieving higher convective volumes.
与血液透析相比，高通量在线血液透析滤过可实现更高的清除率和更低的中分子毒素预透析浓度，但它对蛋白结合尿毒症毒素的影响尚无定论。在这项研究中，我们研究了血液透析滤过与高通量血液透析相比是否会影响预透析时血浆中硫酸吲哚酚、对甲酚硫酸盐和吲哚-3-乙酸的水平。
这是一项多中心、随机对照试验 HDFit（ClinicalTrials.gov：NCT02787161）的事后分析。在基线、3 个月和 6 个月时，采用高效液相色谱法测定尿毒症毒素。使用线性混合效应模型分析血液透析滤过和高通量血液透析之间预透析尿毒症毒素浓度每月变化的平均差异。
共分析了 193 名患者（平均年龄 53 岁，71%为男性）。两组患者在基线时的临床和生化特征以及透析疗程和整个随访过程中的血液流量均无差异。高通量血液透析与血液透析滤过相比，变化率（μM/月，[置信区间 CI]）的平均差异分别为 2.4 [0.3 至 4.56]、3.94 [-1.54 至 9.41]和 0.06 [-0.6 至 0.5]，分别为硫酸吲哚酚、对甲酚硫酸盐和吲哚-3-乙酸。在探索性分析中，在对流体积>27.5 L 的高通量血液透析与血液透析滤过亚组中，这些差异分别为 2.86 [0.43 至 5.28]、7.43 [0.7 至 14.16]和-0.19 [-0.88 至 0.50]。
这些探索性发现表明，与标准高通量血液透析相比，血液透析滤过更能有效降低硫酸吲哚酚，而且在达到更高对流体积的患者中，这种作用也扩展到了对甲酚硫酸盐。
