Bratsiakou Adamantia, Papasotiriou Marios, Davoulou Panagiota, Georgopoulou Georgia Andriana, Papachristou Evangelos, Goumenos Dimitrios S
Department of Nephrology and Kidney Transplantation, University Hospital of Patras, School of Medicine, University of Patras, 26504 Patras, Greece.
Int J Mol Sci. 2025 Jun 16;26(12):5747. doi: 10.3390/ijms26125747.
Patients on standard hemodialysis (HD) show insufficient clearance of medium-molecular-weight uremic toxins, resulting in long-term complications. In this study we investigated the effectiveness of expanded HD (xHD) in the clearance of medium-molecular-weight uremic substances. This prospective study included patients on standard thrice-weekly HD. Participants were treated with xHD for 4 weeks, and the clearance of urea and β2-microglobulin was measured at the beginning and at the end of the study and compared with standard HD (sHD). Moreover, we investigated the clearance of Su-PAR, MCP-1, and activin, comparing sHD, xHD, and online hemodiafiltration (HDF). xHD had the same efficiency in the removal of low-molecular-weight substances compared to sHD but led to a significant decrease in β2-microglobulin levels from the first application of the method (sHD: from 36.9 ± 10.6 to 39.7 ± 18.9 mg/dL, = 0.595 vs. 1st xHD: from 40 (36.5, 41.8) to 11 (9.8, 13.2) mg/dL, = 0.008 vs. after 4 weeks on xHD: from 31.5 (28.5, 34.5) to 8.7 (8.2, 9.0) mg/dL, = 0.008). Moreover, pre-session β2-microglobulin levels significantly decreased after 4 weeks on xHD. Su-PAR, MCP-1, and activin during xHD were also significantly reduced. xHD leads to a significant and cumulative reduction in medium-molecular-weight uremic toxins compared to standard HD.
接受标准血液透析（HD）的患者对中分子尿毒症毒素的清除不足，会导致长期并发症。在本研究中，我们调查了延长血液透析（xHD）对清除中分子尿毒症物质的有效性。这项前瞻性研究纳入了每周进行三次标准HD的患者。参与者接受了4周的xHD治疗，并在研究开始和结束时测量尿素和β2-微球蛋白的清除率，并与标准HD（sHD）进行比较。此外，我们还比较了sHD、xHD和在线血液透析滤过（HDF）对可溶性尿激酶型纤溶酶原激活物受体（Su-PAR）、单核细胞趋化蛋白-1（MCP-1）和激活素的清除情况。与sHD相比，xHD在清除低分子物质方面具有相同的效率，但从首次应用该方法开始，β2-微球蛋白水平就显著下降（sHD：从36.9±10.6降至39.7±18.9mg/dL，P = 0.595；vs. 首次xHD：从40（36.5，41.8）降至11（9.8，13.2）mg/dL，P = 0.008；vs. xHD治疗4周后：从31.5（28.5，34.5）降至8.7（8.2，9.0）mg/dL，P = 0.008）。此外，在接受xHD治疗4周后，透析前β2-微球蛋白水平也显著下降。xHD期间的Su-PAR、MCP-1和激活素也显著降低。与标准HD相比，xHD能显著且持续地降低中分子尿毒症毒素水平。
