Clinical Study on Four-Versus Two-Hour Hemoadsorption Combined with Hemodialysis for Enhanced Claerance of Protein-Bound Uremic Toxins in Maintenance Hemodialysis Patients

INTRODUCTION: The optimal duration of hemoadsorption durations combined with hemodialysis (HAHD) for maintenance hemodialysis (MHD) patients remains unclear. METHODS: In this randomized controlled trial, we randomized 100 MHD patients to receive either 2h-HAHD group (HD+2h-HP, n=50) or 4h-HAHD group (HD+4h-HP, n=50) to compare treatment safety and efficacy profiles, with an additional 8 patients enrolled for hemoadsorber saturation assessment. This study received ethical approval from the Institutional Review Board (IRB No. [2024] No. 14). RESULTS: Results showed that both treatments significantly reduced serum levels of parathyroid hormone (PTH), and β2-microglobulin (β2-MG), hippuric acid (HA), indole-3-acetic acid (IAA), p-cresyl sulphate (PCS), and kynurenine (KYN) (P < 0.05), with the 4h-HAHD group demonstrating greater clearance of indoxyl sulphate (IS) (P < 0.05) and significantly higher removal rates for HA, IAA, IS, PCS, and KYN compared to 2h-HAHD (P < 0.05). While protein-bound uremic toxins (PBUTs) clearance was similar at 2 hours, the 4h-HAHD group achieved superior HA and IAA clearance by 4 hours (P < 0.05). Both treatments were well-tolerated, with no hematologic abnormalities and comparable adverse event rates. CONCLUSION: These findings suggest that 4h-HAHD offers enhanced PBUTs clearance over 2h-HAHD while maintaining a favorable safety profile, supporting its clinical utility in MHD patients.