Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Department of Oncology, University of Oxford, Oxford, UK.
Blood Purif. 2024;53(9):732-742. doi: 10.1159/000539396. Epub 2024 May 22.
Combined hemodialysis (HD) and hemadsorption (HA) therapy has shown the highest clearance rates for middle and large-sized uremic toxin molecules and reduced mortality rates among maintenance HD (MHD) patients. This study aimed to investigate the effectiveness of combined HD and HA therapy in patients undergoing MHD.
Forty patients with end-stage renal disease (ESRD) were divided into three groups: HD only (14), HD + biweekly HA (14), and HD + weekly HA (12). The duration of the study was 8 weeks. Uremic toxins (β2-microglobulin, leptin, parathyroid hormone), inflammatory markers (interleukin-6, C-reactive protein), and symptoms (appetite, pruritus, sleep quality) were assessed before the start and at the completion of therapy. Changes in the parameters were compared between the three groups. Mean differences of parameters in each group were also compared between before and after therapy.
Decrease in BUN level (-61.34 mg/dL [95% CI: -71.33 to -51.34], p < 0.0001) and pruritus score (-3.93 [95% CI: -6.89 to -0.97], p = 0.013) was significantly larger in HD + biweekly HA group compared to the others. Only HD + biweekly HA group showed significant reductions in CRP level (-0.10 mg/L [95%: -0.18 to -0.01], p = 0.034), VAS appetite score (10.43 [95% CI: 4.99-15.87], p = 0.001), and pruritus score (-3.93 [95% CI: -6.89 to -0.97], p = 0.013) after therapy. Both HD + biweekly HA (-2.79 [95% CI: -4.97 to -0.60], p = 0.016) and HD + weekly HA group (-2.33 [95% CI: -4.59 to -0.08], p = 0.044) exhibited a significant improvement in sleep quality score after therapy.
HD combined with a biweekly HA is associated with a greater reduction in BUN level and better improvement of pruritus in ESRD patients compared to HD alone. HD + biweekly HA can significantly reduce CRP levels, alleviate pruritus, improve appetite, and enhance sleep quality.
联合血液透析（HD）和血液吸附（HA）治疗对中大分子尿毒症毒素具有最高的清除率，并降低维持性血液透析（MHD）患者的死亡率。本研究旨在探讨 MHD 患者中联合 HD 和 HA 治疗的效果。
将 40 例终末期肾病（ESRD）患者分为三组：仅 HD（14 例）、HD+双周 HA（14 例）和 HD+每周 HA（12 例）。研究持续 8 周。在治疗前和治疗结束时评估尿毒症毒素（β2-微球蛋白、瘦素、甲状旁腺激素）、炎症标志物（白细胞介素-6、C 反应蛋白）和症状（食欲、瘙痒、睡眠质量）。比较三组之间参数的变化。还比较了每组治疗前后参数的平均差异。
与其他两组相比，HD+双周 HA 组的 BUN 水平下降（-61.34mg/dL[95%CI：-71.33 至-51.34]，p<0.0001）和瘙痒评分下降（-3.93[95%CI：-6.89 至-0.97]，p=0.013）更为显著。仅 HD+双周 HA 组的 CRP 水平（-0.10mg/L[95%：-0.18 至-0.01]，p=0.034）、VAS 食欲评分（10.43[95%CI：4.99-15.87]，p=0.001）和瘙痒评分（-3.93[95%CI：-6.89 至-0.97]，p=0.013）显著降低。HD+双周 HA（-2.79[95%CI：-4.97 至-0.60]，p=0.016）和 HD+每周 HA 组（-2.33[95%CI：-4.59 至-0.08]，p=0.044）在治疗后睡眠质量评分均显著改善。
与单独 HD 相比，HD 联合双周 HA 可更有效地降低 ESRD 患者的 BUN 水平和瘙痒症状。HD+双周 HA 可显著降低 CRP 水平，缓解瘙痒，改善食欲，提高睡眠质量。
