Optimizing the Priming Process for Hemoadsorption Combined with Hemodialysis (HAHD): A Two-Stage In Vitro and...

Conventional priming for Hemoadsorption Combined with Hemodialysis (HAHD) is complex, time-consuming, and resource-intensive. We aimed to develop and validate a standardized, efficient, and safe tandem priming protocol by systematically evaluating its operational efficiency, circuit cleanliness, clinical efficacy and clinical safety.

A two-stage "in vitro screening-clinical validation" design was utilized, using the HA130 hemoadsorption cartridge (Jafron, China) throughout all experiments and clinical sessions. The in vitro phase compared four novel tandem priming methods (varying slow-prime flow rates and fast-flush volumes) against a traditional separate-priming method to identify an optimal protocol based on efficiency and cleanliness. This protocol was then validated in a single-center, single-blind randomized controlled trial involving 53 maintenance hemodialysis patients randomized to the optimized tandem method (n = 29) or the traditional method (n = 24). The primary safety outcome was circuit clotting; the primary efficacy outcome was in solute clearance.

In vitro, all tandem methods were significantly faster (26.05-34.89 min vs. 55.40 min, P < 0.001) and consumed fewer resources while meeting all cleanliness standards. After preliminary safety screening excluded a faster flow rate (100 mL/min), the 50 mL/min slow-prime with 2000 mL fast-flush protocol was selected. In the clinical trial, the incidence of Grade I cartridge clotting was low and statistically comparable between the tandem (3.45%) and traditional (4.17%) groups (P > 0.05). Solute reduction values for urea, creatinine, and β2-microglobulin were not significantly different, demonstrating comparable therapeutic efficacy.

The novel tandem priming protocol is a highly efficient, resource-sparing, and safe alternative to traditional methods. It maintains therapeutic efficacy and circuit patency, offering a valuable, standardized solution for clinical practice.