title: Combination of maintenance hemodialysis with hemoperfusion: a safe and effective model of artificial kidney.
abstract: OBJECTIVE
  To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the clearance rate of middle and large molecule uremic toxins so as to improve the quality of life of MHD patients and reduce their mortality rate.
  
  
  METHODS
  This study was a prospective, randomized, controlled clinical trial. 100 MHD patients were selected and then randomly divided into two groups after four weeks of run-in period. Group 1 received HD alone 2 times a week and the combined treatment of HD with HP (HD+HP) once a week, whereas Group 2 was given HD alone 3 times a week. This study was followed up for a mean of 2 years. The primary outcome was the death of patients. Secondary end points included normal clinical data, leptin, high sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), ß(2) microglobulin (ß(2)-MG), immunoreactive parathyroid hormone (iPTH), tumor necrosis factor-α (TNF-α) and the index of dimensions of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36 Chinese Edition ).
  
  
  RESULTS
  At the end of the two-year observation, the serum concentration of leptin, hsCRP, iPTH, IL-6, ß(2)-MG and TNF-α, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), cardiothoracic ratio, left ventricular mass index (LVMI), the EPO doses and the types of antihypertensive drugs used were lower with Group 1 than with Group 2 (p<0.05); Group 1 had higher hemoglobin (Hb), ejection fraction (EF), and body mass index (BMI) (p<0.05). No statistical difference between the two groups was observed in terms of serum albumin, serum iron (SI), total iron binding capacity (TIBC), cardiac output (CO), Kt/V, early/atrial mitral inflow velocities (E/A) (p>0.05). Besides, the SF-36 indicated that the total score of overall dimentions of Group 1 was higher than Group 2 (p<0.05) and the quality of life of Group 1 was evidently better than Group 2. The Kaplan-Meier Survival Curves for the 2-year observation period showed that patients in Group 1 had obvious survival advantage while Log-rank test results showed p<0.05. No serious adverse incidents occurred during the HD+HP treatment.
  
  
  CONCLUSIONS
  HD+HP was superior to HD in regularly eliminating middle and large molecule uremic toxins accumulated in the body. These findings suggest a potential role for HD+HP in the treatment to improve the quality of life and survival rate of MHD patients.
authors.affiliation: Department of Nephrology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai - China.
authors.forename: Shun-Jie
authors.initials: SJ
authors.lastname: Chen
authors.forename: Geng-Ru
authors.initials: GR
authors.lastname: Jiang
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Shan
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.forename: Hai-Dong
authors.initials: HD
authors.lastname: Huang
authors.forename: Gang
authors.initials: G
authors.lastname: Ji
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.forename: Gu-Feng
authors.initials: GF
authors.lastname: Wu
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Chun
authors.initials: C
authors.lastname: Zhu
authors.forename: Fan
authors.initials: F
authors.lastname: Bian
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D002681:China; D005260:Female; D006339:Heart Rate; D006397:Hematinics / Q000627:therapeutic use; D006464:Hemoperfusion / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D007688:Kidneys, Artificial; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014511:Uremia / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D006397:Hematinics