AUTHOR=Biedunkiewicz Jan , Zakrzewska Agnieszka , Małgorzewicz Sylwia , Komorniczak Michał , Jasiulewicz Katarzyna , Płonka Natalia , Tarasewicz Agnieszka , Jankowska Magdalena , Biedunkiewicz Bogdan , Dębska‐Ślizień Alicja , Tylicki Leszek 

TITLE=Comparison of uremic toxin removal between expanded hemodialysis and high volume online hemodiafiltrations in different modes

JOURNAL=Acta Biochimica Polonica

VOLUME=Volume 71 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/acta-biochimica-polonica/articles/10.3389/abp.2024.13715

DOI=10.3389/abp.2024.13715

ISSN=1734-154X

ABSTRACT=Various high-efficiency hemodialysis techniques exist, including different online high-volume hemodiafiltration (HDF) modes and expanded hemodialysis (HDx) utilizing dialyzers with medium cut-off (MCO) membranes. This study aimed to evaluate the efficacy of uremic toxin removal among four modalities: (I) HDx, (II) pre-dilution HDF (PRE-HDF), (III) mixed-dilution HDF (MIX-HDF), and (IV) post-dilution HDF (POST-HDF), each applied for one week in a randomized order. This research was a single-center, prospective, openlabel, exploratory crossover study. The reduction ratio (RR) for small molecular toxins (urea and phosphate), a middle molecular toxin (beta-2-microglobulin, β2M), a large-middle molecular toxin (Chitinase-3-like protein 1, YKL-40), and a protein-bound uremic toxin (indoxyl sulfate, IS) was evaluated during a single mid-week dialysis session. Twelve patients were included, with an average age of 52.5 ± 15.47 years and an average dialysis duration of 42.05 ± 31.04 months. The dialysis parameters, including post-dialysis weight, session duration, dialysate composition, blood and dialysate flow rates, dialysate temperature, and anticoagulation dosage, were maintained consistently across all modalities. No significant differences in RR for urea, phosphate, β2M, YKL-40, and IS were observed between the treatments.Although the highest IS clearance, though not statistically significant, was observed with POST-HDF and HDx, the differences were not substantial enough to favor any particular modality as the most effective.volume online hemodiafiltrations in different modes.