Yu Shaobin, Yuan Huaihong, Xiong Xiaohong, Zhu Yalin, Fu Ping
Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China.
Toxins (Basel). 2025 Aug 5;17(8):392. doi: 10.3390/toxins17080392.
Protein-bound uraemic toxins (PBUTs), such as indoxyl sulphate (IS) and p-cresyl sulphate (PCS), are poorly cleared by conventional haemodialysis (HD) or haemodiafiltration (HDF). Haemoadsorption combined with HD (HAHD) using the novel pHA130 cartridge may increase PBUT removal, and this trial aimed to compare its efficacy and safety with HDF in patients with end-stage renal disease (ESRD). In this single-centre, open-label trial, 30 maintenance HD patients were randomized (1:1:1) to HDF once every two weeks (HDF-q2w), HAHD once every two weeks (HAHD-q2w), or HAHD once weekly (HAHD-q1w) for 8 weeks, with the primary endpoint being the single-session reduction ratio (RR) of IS. The combined HAHD group (n = 20) demonstrated a significantly greater IS reduction than the HDF-q2w group (n = 10) (46.9% vs. 31.8%; = 0.044) and superior PCS clearance (44.6% vs. 31.4%; = 0.003). Both HAHD regimens significantly reduced predialysis IS levels at Week 8. Compared with HDF, weekly HAHD provided greater relief from pruritus and improved sleep quality, with comparable adverse events among groups. In conclusion, HAHD with the pHA130 cartridge is more effective than HDF for enhancing single-session PBUT removal and alleviating uraemic symptoms in patients with ESRD, with weekly application showing optimal symptomatic benefits.
蛋白结合型尿毒症毒素（PBUTs），如硫酸吲哚酚（IS）和对甲酚硫酸盐（PCS），通过传统血液透析（HD）或血液透析滤过（HDF）难以清除。使用新型pHA130滤器的血液吸附联合HD（HAHD）可能会增加PBUT的清除，本试验旨在比较其与HDF在终末期肾病（ESRD）患者中的疗效和安全性。在这项单中心、开放标签试验中，30例维持性HD患者被随机分为三组（1:1:1），分别接受每两周一次的HDF（HDF-q2w）、每两周一次的HAHD（HAHD-q2w）或每周一次的HAHD（HAHD-q1w），为期8周，主要终点是IS的单次治疗降低率（RR）。联合HAHD组（n = 20）的IS降低幅度显著大于HDF-q2w组（n = 10）（46.9%对31.8%；P = 0.044），PCS清除率更高（44.6%对31.4%；P = 0.003）。两种HAHD方案在第8周时均显著降低了透析前IS水平。与HDF相比，每周一次的HAHD能更有效地缓解瘙痒并改善睡眠质量，各组不良事件发生率相当。总之，使用pHA130滤器的HAHD在增强ESRD患者单次治疗PBUT清除和缓解尿毒症症状方面比HDF更有效，每周应用显示出最佳的症状改善效果。
