Ramírez-Guerrero Gonzalo, Reis Thiago, Segovia-Hernández Barbara, Aranda Francisca, Verdugo Constanza, Pedreros-Rosales Cristian, Marcello Matteo, León Janina, Rojas Armando, Galli Francesco, Ronco Claudio
Nephrology and Dialysis Unit, Carlos Van Buren Hospital, Valparaíso, Chile.
International Renal Research Institute of Vicenza, Vicenza, Italy.
Artif Organs. 2025 May;49(5):900-906. doi: 10.1111/aor.14954. Epub 2025 Jan 21.
Patients on maintenance hemodialysis (HD) face complications due to the accumulation of protein-bound uremic toxins, such as advanced glycation end products (AGEs), which contribute to inflammation, oxidative stress, and cardiovascular disease. Conventional HD techniques inadequately remove AGEs. This study evaluates the efficacy of the HA130 hemoadsorption cartridge combined with high-flux HD (HF-HD) in enhancing AGE removal.
This prospective, single-center study included 20 maintenance HD patients randomized into two groups: HF-HD alone (n = 10) and HF-HD plus hemoadsorption (n = 10). Blood samples were collected before and after a single session to measure carboxymethyllysine (CML), soluble RAGE (sRAGE), prolactin, and parathyroid hormone (PTH) levels. Reduction ratios (RR) were calculated, including corrected for hemoconcentration (RRc), to ensure accuracy. Statistical analyses included Mann-Whitney U and Chi-square tests.
The HF-HD plus hemoadsorption group showed significantly enhanced removal of CML compared to HF-HD alone, with RRc of 64.7% [52.6-74.9] versus 39.3% [33.8-49.4], respectively (p = 0.045). Similarly, uncorrected reduction ratios demonstrated a trend favoring hemoadsorption, with values of 57.5% [45.1-70.7] versus 30.3% [19.1-44.5] (p = 0.053). Importantly, sRAGE levels were preserved in both groups (RRc: 23.4% (15.1-30.4) vs. 21.8% (16.6-31.7), p = 0.791), highlighting the safety of hemoadsorption. Other biochemical parameters, including prolactin, PTH, albumin, and electrolytes, showed no significant differences between groups. All sessions were completed without adverse events.
Combining hemoadsorption with HF-HD significantly enhances CML removal, as evidenced by corrected RR, without compromising protective sRAGE levels. This innovative approach offers a promising adjunctive therapy for reducing AGEs-related complications in end-stage renal disease patients. Further longitudinal studies are needed to confirm these findings and evaluate long-term outcomes.
维持性血液透析（HD）患者因蛋白质结合尿毒症毒素（如晚期糖基化终末产物（AGEs））的蓄积而面临并发症，这些毒素会导致炎症、氧化应激和心血管疾病。传统的血液透析技术不能充分清除AGEs。本研究评估HA130血液吸附柱联合高通量血液透析（HF-HD）增强AGEs清除的疗效。
这项前瞻性单中心研究纳入了20例维持性血液透析患者，随机分为两组：单纯HF-HD组（n = 10）和HF-HD联合血液吸附组（n = 10）。在单次治疗前后采集血样，检测羧甲基赖氨酸（CML）、可溶性RAGE（sRAGE）、催乳素和甲状旁腺激素（PTH）水平。计算清除率（RR），包括校正血液浓缩后的清除率（RRc），以确保准确性。统计分析包括Mann-Whitney U检验和卡方检验。
与单纯HF-HD组相比，HF-HD联合血液吸附组CML清除率显著提高，RRc分别为64.7%[52.6-74.9]和39.3%[33.8-49.4]（p = 0.045）。同样，未校正的清除率也显示出有利于血液吸附的趋势，分别为57.5%[45.1-70.7]和30.3%[19.1-44.5]（p = 0.053）。重要的是，两组sRAGE水平均得以保留（RRc：23.4%（15.1-30.4）对21.8%（16.6-31.7），p = 0.791），突出了血液吸附的安全性。其他生化参数，包括催乳素、PTH、白蛋白和电解质，两组间无显著差异。所有治疗均顺利完成，无不良事件发生。
血液吸附联合HF-HD显著提高CML清除率，校正后的RR证明了这一点，且不影响保护性sRAGE水平。这种创新方法为减少终末期肾病患者与AGEs相关的并发症提供了一种有前景的辅助治疗方法。需要进一步的纵向研究来证实这些发现并评估长期结果。
