Comparative efficacy between hemodialysis using super high‐flux dialyzer with hemoperfusion and high‐volume postdilution online hemodiafiltration in removing protein bound and middle molecule uremic toxins: A cross‐over randomized controlled trial

Background: Hemodialysis (HD) using super high‐flux dialyzer (HD + SHF) comparably removed uremic toxins to high‐volume postdilution online hemodiafiltration (olHDF). Integration of hemoperfusion (HP) to HD + SHF (HD + SHF + HP) might provide superior uremic toxin removing capability to high‐volume postdilution olHDF. Method: The present study was conducted in thrice‐a‐week HD patients to compare the efficacy in removing indoxyl sulfate (IS), beta‐2 microglobulin (β2M), and urea between high‐volume postdilution ol‐HDF and HD + SHF + HP, comprising HD + SHF as the main treatment plus HD + SHF + HP 1/week in the first 4 weeks and 1/2 weeks in the second 4 weeks. Results: Ten prevalent HD patients with blood flow rate (BFR) above 400 ml/min were randomized into two sequences of 8‐week treatment periods of HD + SHF + HP and later high‐volume postdilution olHDF or vice versa. When compared with high‐volume postdilution olHDF (convective volume of 26.02 ± 1.8 L/session), HD + SHF + HP provided comparable values of percentage reduction ratio of IS (52.0 ± 11.7 vs. 56.3 ± 7.5%, p = 0.14) and β2M (83.7 ± 4.9 vs. 84.0 ± 4.3%, p = 0.37) and slightly lower urea reduction ratio. Despite greater dialysate albumin loss (p = 0.008), there was no significant change in serum albumin level in HD + SHF + HP group. Conclusions: HD + SHF + HP could not provide superior efficacy in removing uremic toxins to high‐volume postdilution olHDF. The use of low BFR of 200 ml/min during the first 2 h of HD + SHF + HP session, according to the instruction of manufacturer, might impair the efficacy of the HD + SHF part in removing uremic toxins. [ABSTRACT FROM AUTHOR]