Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 8;18(5):sfaf146.
doi: 10.1093/ckj/sfaf146. eCollection 2025 May.

Comparing hemodialysis and hemodiafiltration performance with and without hemoadsorption

Francisco Maduell  1 , Victor Joaquin Escudero-Saiz  1 , Elena Cuadrado-Payán  1 , Maria Rodriguez-Garcia  2 , Lida María Rodas  1 , Néstor Fontseré  1 , Maria Del Carmen Salgado  2 , Gregori Casals  2 , Nayra Rico  2 , José Jesús Broseta  1
Affiliations

Comparing hemodialysis and hemodiafiltration performance with and without hemoadsorption

Francisco Maduell et al. Clin Kidney J. .

Abstract

Background: New cartridges have been developed using the latest resins for hemoadsorption (HA). When used alongside dialyzers, these cartridges may enhance the removal of certain uremic toxins achieved with classical diffusion and convection. This study aimed to assess the elimination of a wide range of molecular weight solutes, including protein-bound uremic toxins, in hemodialysis (HD) and postdilution hemodiafiltration (HDF) treatments.

Methods: A prospective study was conducted involving 20 patients who underwent six dialysis sessions with routine treatment parameters maintenance, while only the dialysis modality was modified. The modalities included low-flux HD (LFHD), LFHD-HA, high-flux HD (HFHD), HFHD-HA, HDF and HDF-HA.

Results: Urea and creatinine reduction ratios (RR) were higher in HDF treatments (with or without HA) versus LFHD and HFHD treatments. In the same treatment modality, the addition of HA did not modify the small molecules removal. The combination of LFHD-HA showed increased RR of β2-microglobulin, myoglobin, prolactin and lambda-free immunoglobulin light chains (λFLC) compared with HD alone. Similarly, the combination of HFHD-HA showed increased RR of myoglobin, α1-microglobulin and λFLC compared with HFHD alone. However, in terms of HDF, the addition of HA tended to slightly increase RR, but only those of β2-microglobulin were significant. Overall, HDF both with and without HA was clearly superior to LFHD and HFHD treatments. Moreover, regardless of the addition of HA, HFHD was superior to LFHD treatments.

Conclusions: The results confirmed the superiority of postdilution HDF over LFHD and HFHD, as well as HFHD over LFHD. Incorporating adsorption into the standard LFHD diffusion significantly enhanced the removal of uremic toxins, whose clearance is restricted by the dialyzer's pore size. In contrast, incorporating adsorption alongside the typical diffusion and convection resulted in a modest enhancement in HFHD, with similar outcomes for HDF.

Keywords: hemoadsorption; hemodiafiltration; hemodialysis; performance; reduction ratios.

PubMed Disclaimer

Conflict of interest statement

F.M. has received consultancy fees and lecture fees from Baxter, Fresenius Medical Care, Medtronic, Nipro, Nikkiso, Toray and Vifor. J.J.B. has received lecture fees from Fresenius Medical Care. The other authors declare no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Comparison of the reduction ratios of urea (A), 60 Da, and creatinine (B), 113 Da, in all study situations, including LFHD, HFHD and HDF with and without HA.
Figure 2:
Figure 2:
Comparison of the reduction ratios of β2-microglobulin (A), 11 800 Da, and myoglobin (B), 17 200 Da, in all study situations, LFHD, HFHD and HDF with and without HA.
Figure 3:
Figure 3:
Comparison of the reduction ratios κFLC (A), 22 500 Da, and prolactin (B), 23 000 Da, in all study situations, LFHD, HFHD and HDF with and without HA.
Figure 4:
Figure 4:
Comparison of the reduction ratios of α1-microglobulin (A), 33 000 Da, α1-acid glycoprotein (B), 41 000 Da, and λFLC (C), 45 000 Da, in all study situations, LFHD, HFHD and HDF with and without HA.
Figure 5:
Figure 5:
Comparison of the reduction ratios of indoxyl sulphate (A) and p-cresyl sulphate (B) in all study situations, LFHD, HFHD and HDF with and without HA.
Figure 6:
Figure 6:
Comparison of the GRS in all study situations, LFHD, HFHD and HDF with and without HA. GRS formula: formula image.
Figure 7:
Figure 7:
Variations in the GRS associated with changes in dialysis modality or the addition of an HA cartridge.
See this image and copyright information in PMC

References

    1. Locatelli F, Martin-Malo A, Hannedouche T et al. Membrane Permeability Outcome (MPO) study group: effect of membrane permeability on survival of hemodialysis patients. J Am Soc Nephrol 2009;20:645–54. 10.1681/ASN.2008060590 - DOI - PMC - PubMed
    1. Ronco C, Brendolan A, Feriani M et al. A new scintigraphic method to characterize ultrafiltration in hollow fiber dializers. Kidney Int 1992;41:1383–93. 10.1038/ki.1992.203 - DOI - PubMed
    1. Locatelli F, Mastrangelo F, Redaelli B et al. Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters. The Italian Cooperative Dialysis Study Group. Kidney Int 1996;50:1293–302. 10.1038/ki.1996.441 - DOI - PubMed
    1. Maduell F, Moreso F, Pons M et al. ESHOL Study Group . High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 2013;24:487–97. 10.1681/ASN.2012080875 - DOI - PMC - PubMed
    1. Blankestijn PJ, Vernooij RWM, Hockham C et al. CONVINCE Scientific Committee investigators . Effect of hemodiafiltration or hemodialysis on mortality in kidney failure. N Engl J Med 2023;389:700–9. 10.1056/NEJMoa2304820 - DOI - PubMed