ABSTRACT
Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion(HP) can improve the clearance rate of middle- and largemolecule uremic toxins so as to improve the quality of life and reduce the mortality in MHD patients. Methods A prospective, randomized and controlled clinical trial was carried out. One hundred MHD patients were selected and then randomly divided into two groups after four weeks of run-in period. HD+HP group received MHD alone 2 times a week and the combined treatment of HD with HP (HD+HP) once a week, whereas HD group received MHD alone 3 times a week. The follow up lasted for mean 2 years. The primary outcome was the death of patients. Secondary end points included clinical data, leptin, high sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6),β2 microglobulin (β2-MG), parathyroid hormone (PTH), tumor necrosis factor α (TNF-α) and the indexes of dimensions of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36Chinese Edition ). Results At the end of the two-year observation, the serum concentration of leptin, hsCRP, PTH, IL-6, β2-MG and TNF-α, systolic blood pressure (SBP), diastolic blood pressure(DBP), heart rate(HR), cardiothoracie ratio, left ventricular mass index (LVMI), EPO dose and the types of antihypertensive drugs used were lower in HD +HP group as compared to HD group (all P＜0.05). HD+HP group had higher hemoglobin (Hb), ejection fraction (EF) and body mass index (BMI) (all P＜0.05). No significant differences between two groups were found in terms of serum albumin (Alb), serum iron (SI), total iron binding capacity (TIBC), cardiac output (CO),Kt/V, early/atrial mitral inflow velocities (E/A) (all P＞0.05). Besides, the SF-36 indicated that the total score of overall dimensions in HD+HP group was higher (P＜0.05) and the quality of life of HD+HP group was evidently better as compared to HD group. The Kaplan-Meier survival curves for the 2-year observation period showed that patients in HD +HP group had obvious survival advantage, while Log-rank test results showed P＜0.05. No serious adverse incidents occurred during the HD+HP treatment. Conclusion HD+HP is superior to HD in eliminating regularly middleand large-molecules uremic toxins and has a potential role in improving the quality of life and survival rate of MHD patients.