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Kidney Week

Abstract: FR-PO829

Protein-Bound and Large Toxin Removals between Hemodialysis Using High Cut-off Dialyzers with Adsorptive Cartridge and High-Efficiency Online Hemodiafiltration: A Crossover Randomized Controlled Trial

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD


  • Khemnark, Nutchaya, Chulalongkorn University, Bangkok, Thailand
  • Tiranathanagul, Khajohn, Chulalongkorn University, Bangkok, Thailand
  • Limjariyakul, Maneerut, Chulalongkorn University, Bangkok, Thailand
  • Wittayalertpanya, Supeecha, Chulalongkorn University, Bangkok, Thailand
  • Susantitaphong, Paweena, Chulalongkorn University, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand

Protein-bound toxins especially indoxyl sulfate (IS) which could not be removed by standard hemodialysis (HD) using high-flux dialyzer are obviously correlated with high mortality in HD patients. High-efficiency online hemodiafiltration using high-flux dialyzer (OL-HDF) has been reported to enhance IS removal and improve patient survival. At present, there are certain limitations of OL-HDF including necessity for special machine and high investment cost. Therefore, we proposed a new HD modality which can be performed in any HD centers with standard HD machine by using high cut-off (HCO) dialyzer, PES-17Dα (Nipro, Japan) in combination with hemoperfusion (HP) using HA130 adsorptive cartridge (Jafron, China) and compared with OL-HDF.


This was a cross-over randomized control trial. Ten chronic hemodialysis patients were randomized to consecutively undergo dialysis with either new HD modality (HCO HD with HP) or OL-HDF before cross-over to the other modality for 8-week each period. The efficacy including percentage reduction after dialysis of IS, β2 microglobulin (β2m) and urea were assessed. Patient safety and dialysate albumin loss were monitored. IS was measured by high performance liquid chromatography.


The plasma IS levels significantly decreased in both treatment modalities. The percentage reduction of IS were comparable between HCO HD with HP and OL-HDF (52.0±11.7 vs. 56.3±7.5 %, p=0.28). The percentage reduction of β2m did not differ (83.7±4.9 vs. 84.0±4.3 %, p=0.75). Two techniques provided adequate small solute removal. Although the dialysate albumin loss was significantly higher in HCO HD with HP than OL-HDF (4.2±2.4 vs. 0.5±0.8 g/session; P=0.008), there were no significant long-term changes in serum albumin levels of both modalities.


Standard HD using HCO dialyzer with HP using adsorptive cartridge, which could be performed in any HD centers, can effectively remove IS, β2m, and small toxin in comparable with high cost OL-HDF and could replace OL HDF where it is unavailable.