Combined Hemoperfusion-Hemodialysis in End-Stage Renal Disease Patients

Despite advances in dialysis technology, a high level of morbidity and mortality is still present in end-stage renal disease patients undergoing maintenance dialysis. This has been in great part correlated with accumulation of uremic toxins that cannot be adequately removed by classic dialysis membranes and techniques. Improvements have been made in enhancing both membrane permeability and convection rates as in the case for expanded hemodialysis (HD) and hemodiafiltration, but these techniques still present limitations or cannot be performed due to technical reasons. Considering the abovementioned limitations of current dialysis techniques, the additional use of adsorption as a solute removal mechanism may represent an interesting option. Recent studies have underlined the significant improvement in the levels of medium-large retention solutes and toxin-related symptoms using a combination of hemoperfusion with HD at least in a session per week. These studies need further confirmation, but they may represent the doorway to further improve patient's outcome in maintenance dialysis.