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Updated: May 23, 2025
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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
2.1K
Comparing hemodialysis and hemodiafiltration performance with and without hemoadsorption.
Francisco Maduell1, Victor Joaquin Escudero-Saiz1, Elena Cuadrado-Payán1
1Nephrology Department, Hospital Clínic Barcelona, Barcelona, Spain.
Clinical Kidney Journal
|May 22, 2025
Summary
New hemoadsorption (HA) cartridges enhance toxin removal in dialysis. Post-dilution hemodiafiltration (HDF) is superior to hemodialysis (HD), with HA offering additional benefits for specific toxins in certain HD and HDF configurations.
Area of Science:
- Nephrology
- Biomaterials Science
- Medical Device Engineering
Background:
- Hemoadsorption (HA) cartridges, utilizing advanced resins, are developed to augment toxin removal during dialysis.
- These cartridges, when used with dialyzers, aim to improve the elimination of uremic toxins beyond conventional diffusion and convection.
- The study investigates the efficacy of HA in hemodialysis (HD) and hemodiafiltration (HDF) for a broad spectrum of solutes, including protein-bound toxins.
Purpose of the Study:
- To evaluate the effectiveness of hemoadsorption (HA) cartridges in enhancing the removal of various molecular weight solutes during hemodialysis (HD) and hemodiafiltration (HDF).
- To compare the solute removal efficiency of different dialysis modalities, including low-flux HD (LFHD), high-flux HD (HFHD), and postdilution HDF, with and without the addition of HA.
- To assess the impact of HA on the clearance of protein-bound uremic toxins, which are challenging to remove with conventional dialysis.
Main Methods:
- A prospective study involving 20 patients undergoing six dialysis sessions.
- Dialysis modalities were systematically varied, including low-flux HD (LFHD), LFHD with HA (LFHD-HA), high-flux HD (HFHD), HFHD with HA (HFHD-HA), postdilution HDF, and HDF with HA (HDF-HA).
- Routine treatment parameters were maintained, with only the dialysis modality being altered between sessions.
Main Results:
- Hemodiafiltration (HDF) treatments, with or without HA, demonstrated higher urea and creatinine reduction ratios (RR) compared to LFHD and HFHD.
- The addition of HA did not significantly alter small molecule removal within the same treatment modality.
- LFHD-HA showed increased RR for β2-microglobulin, myoglobin, prolactin, and lambda-free immunoglobulin light chains (λFLC) compared to LFHD alone. HFHD-HA similarly increased RR for myoglobin, α1-microglobulin, and λFLC compared to HFHD alone.
- HDF with HA showed a modest, but significant, increase in β2-microglobulin RR compared to HDF without HA.
Conclusions:
- Postdilution HDF is superior to LFHD and HFHD for solute removal, and HFHD is superior to LFHD.
- Integrating HA with LFHD significantly improves the removal of uremic toxins limited by dialyzer pore size.
- The addition of HA provides modest benefits in HFHD and HDF, particularly for specific toxins like β2-microglobulin, when used with convection-enhanced therapies.
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