Comparable Efficacy of Medium Cut-Off Dialysis Plus HA130 Hemoadsorption and Postfilter Hemodiafiltration in Removing Protein-Bound Uremic Toxins.

Rationale & Objective: Protein-bound uremic toxins, including indoxyl sulfate and Study Design: Prospective, single-center, parallel-group, single-session comparative study. Setting & Participants: Twenty anuric adult patients undergoing maintenance hemodialysis treated at a tertiary dialysis center were allocated to medium cut-off dialysis with hemoadsorption (n = 10) or postfilter hemodiafiltration (n = 10). Exposure: Expanded hemodialysis using a medium cut-off membrane combined with HA130 hemoadsorption versus postfilter hemodiafiltration. Outcomes: Corrected reduction ratios of protein-bound uremic toxins (indoxyl sulfate, Analytical Approach: Predialysis and postdialysis plasma concentrations were measured, and corrected reduction ratios were calculated after adjusting for hemoconcentration. Between-group comparisons were performed using nonparametric tests. Results: Corrected reduction ratios for key protein-bound uremic toxins were similar between medium cut-off dialysis with hemoadsorption and hemodiafiltration. Indoxyl sulfate corrected reduction ratios were 28.0% (IQR, 21.6-41.7) with medium cut-off dialysis with hemoadsorption and 26.0% (IQR, 22.5-37.9) with hemodiafiltration, while Limitations: Small sample size, single-session design, and reliance on plasma reduction ratios without direct dialysate mass measurements. Conclusions: In this exploratory study, medium cut-off dialysis with hemoadsorption achieved protein-bound uremic toxin removal similar to that of optimized postfilter hemodiafiltration, despite lower clearance of conventional middle molecules. Hybrid strategies integrating diffusion, convection, and adsorption may expand protein-bound uremic toxin removal options, particularly where hemodiafiltration is not feasible.