Abstract: TH-PO248
Hemodialysis Coupled with Hemadsorption: Benefits on Uremic Toxins Retention and Oxidative Stress
Session Information
- Hemodialysis, Hemodiafiltration, and Frequent Dialysis
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Marcello, Matteo, Ospedale San Bortolo di Vicenza, Vicenza, Italy
- Virzì, Grazia Maria, Ospedale San Bortolo di Vicenza, Vicenza, Italy
- Cantaluppi, Vincenzo, Universita degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Piemonte, Italy
- Brendolan, Alessandra, Ospedale San Bortolo di Vicenza, Vicenza, Italy
- Ronco, Claudio, Ospedale San Bortolo di Vicenza, Vicenza, Italy
Background
Retention of middle-molecules and Protein Bound Uraemic Toxins (PBUT) in dialysis patients increases morbidity and mortality. Current dialysis techniques do not adequately clear these toxins. Furthermore, in dialysis patients, there’s an increased inflammation and oxidative stress only partially attenuated by biocompatibility of newly developed membranes. This pathologic inflammatory response is associated to a particular form of programmed cellular death involving red blood cells, called Eryptosis. This study aimed to assess the safety of dialysis coupled with hemadsorption (HA+HD) in terms of biocompatibility and efficacy in terms of removal of middle-molecules and PBUTs.
Methods
This analysis of a multicentre observational study evaluated 4 dialysis sessions focusing on 7 chronic dialysis patients of our dialysis center. Patients were treated with HA+HD with HA130 cartridge (Jafron) in the early-week dialysis session and then returned to their usual prescription. Blood samples were taken before and after the dialysis session to measure Eryptosis as a marker of biocompatibility and a few uremic toxins to assess the efficacy of the treatment by using Removal Ratio.
Results
This study was carried out on 7 patients (4 women) with a mean age of 65.7 ± 11.5 years and a median dialysis vintage of 33 months (IQR 28-51). All patients had AVF with Qb of 330 ml/min. Dialysis lenght was 210 minutes. We didn’t find any differences between Eryptosis values measured before and after dialysis (Table 1), and between different timepoints. We found significant reduction of PTH (pre: 391.5 ng/L, IQR 206.5-602.8 vs post: 162.0 ng/L, IQR 95.0-363.3; p=0.005) and β2-microglobulin (pre: 23.10 mg/L, IQR 22.1-24.1 vs post: 6.72 mg/L, IQR 6.2-8.3;p>0.005) throughout the HA+HD session.
Conclusion
We found that the addition of Hemadsorption allows a great removal of middle molecular-weight uremic toxins without compromising biocompatibility and thus represents a better treatment option in patients with high retention of these toxins.
Eryptosis values pre and post dialysis session
| pre | post | p | |
| session 1 | 0.40, IQR 0.3-0.55 | 0.25, IQR 0.2-0.38 | 0.31 |
| session 2 | 0.20, IQR 0.2-0.35 | 0.30, IQR 0.2-0.4 | 0.57 |
| session 3 | 0.20, IQR 0.2-0.45 | 0.40, IQR 0.25-0.55 | |
| session 4 | 0.30, IQR 0.15-2.9 | 0.20, IQR 0.15-0.35 |