Long-term Clinical Study Of Hemodialysis Combined With Hemoperfusion On Clearance Of Protein-bound Uremic Toxins In Maintenance Hemodialysis Patients

Protein-bound uremic toxins are difficult to be cleared by conve ntional hemodialysis because of their binding to proteins and the char-acteristics of multi-compartmental distribution.Hemodialysis combined with hemoperfusion can increase the clearance of protein-bound ure mic toxins compared with conventional hemodialysis.The distribution volume of PBUTs is much larger than that of plasma volume,longterm hemoperfusion therapy can keep PBUTs at a low level is unkno wn.Therefore,this study aims to observe the effect of long-term He modialysis combined with hemoperfusion on the level of protein-boun d uremic toxins in maintenance hemodialysis patients,while observing the impact on quality of life.Thirty-six patients with maintenance hemodialysis were selected and divided into HD+HP group(n=22)and HD group(n=24).HD+HP group was treated with low-flux hemodialysis two times a week and combined treatment of HD and HP once a week,HD group was treated with low-flux hemodialysis three times a week.A total of 36 weeks of follow-up period,the concentration of PBUTs??2-MG in pre-dialysis were measured at week 12,24,36 and baseline,and observe the change of clinical parameters at the beginning of treatment and the end of treatment,the KDQOL-SF1.3 scale was used to assess the quality of life.PBUTs included hippuric acid(HA),indoxyl sulfate(IS),P-cresyl sulphate(PCS),the method of determination is high performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS).The clinical parameters include Serum calcium,Serum phosphorus,Intact parathyroid hormone,Serum albumin,Hemoglobin,Serum Ferritin,Serum Transferrin saturation,Dialysis adequacy(Kt/V).After 36 weeks of treatment,1.The clinical parameters in HD group and HD+HP group had no statistical difference compared with baseline(P>0.05),there was no significant difference between the HD group and HD+HP group after the treatment(P>0.05);2.The concentration of the ?2-MG in the HD + HP group was lower than those in the HD group during the whole study.At the end of study,the reduction rate of ?2-MG were 15.6%,significantly lower than pre-treatment(P<0.01),HD group decreased by 1.2%,there was no significant difference between before and after treatment(P>0.05),the clearance of ?2-MG in the HP+HD group higher than HD group(P<0.05);3.The concentration of PBUTs in the HD + HP group was lower than those in the HD group during the whole study.At the end of study,the reduction rate of HA,IS,PCS were 33.5%?12.8%?24.2%,respectively,in HD+HP group;HD group increased by 2.3%?21.8%?2.8%.The clearance of HA?PCS?IS in the HP+HD group higher than HD group(P<0.05).4.The quality of life(bodily pain,energy)of the HD group was significantly lower than pre-treatment(P<0.05),the quality of life(dialysis-related symptoms,effects of kidney disease,vitality)of the HD+HP group than pre-treatment significantly improved(P<0.05),The quality of life(effects of kidney disease,cognitive function,sleep,physical function,bodily pain,general health,social function and vitality)were significantly better in HD + HP group than in HD group(P<0.05).In summary,long-term use of hemodialysis combined with hemo-perfusion(once a week)in the treatment of protein-bound uremic to xins and middle-molecules clearance was significantly better than con ventional hemodialysis,and significantly improved quality of life in maintenance hemodialysis patients.