Hemodiafiltration with endogenous reinfusion for uremic toxin removal in patients undergoing maintenance hemodialysis: a pilot study

Figures & data

Table 1. Comparison of parameters pre- and post-HFR and HDF treatments.

Variables	HFR (n = 20)	HDF (n = 20)	p-Value
Treatment duration (Hours)	4.0	4.0	1.0
Blood flow rate (ml/min)	252.6 ± 17.3	257.9 ± 18.4	0.145
Dialysis fluid flow rate (ml/min)	500	500	1.0
Replacement fluid volume (L)	13.05 ± 1.43	13.26 ± 2.94	0.638
Ultrafiltration volume (L)	2.58 ± 1.0	2.58 ± 0.9	0.991
Low molecular weight heparin dosage (IU)	3968.4 ± 671.7	4084.2 ± 578.6	0.331
Pretreatment weight (Kg)	73.00 ± 13.58	73.11 ± 13.54	0.331
Post-treatment weight (Kg)	70.74 ± 13.56*	70.74 ± 13.55*	1.0
Pretreatment body temperature (°C)	36.16 ± 0.38	36.0 ± 0.0	0.083
Post-treatment body temperature (°C)	36.0 ± 0.00	36.0 ± 0.00	1.0
Pretreatment systolic blood pressure (mmHg)	137.16 ± 24.14	148.79 ± 22.54	0.011
Post-treatment systolic blood pressure (mmHg)	139.21 ± 22.61	143.26 ± 25.37	0.356
Pretreatment diastolic blood pressure (mmHg)	81.95 ± 12.43	77.79 ± 11.51	0.138
Post-treatment diastolic blood pressure (mmHg)	85.05 ± 10.97	77.53 ± 12.24	0.002
Pretreatment heart rate (breaths per minute)	74.32 ± 11.0	75.79 ± 11.7	0.533
Post-treatment heart rate (breaths per minute)	75.95 ± 13.77	73.53 ± 12.51	0.439
Pretreatment respiratory rate (breaths per minute)	18.68 ± 2.56	19.0 ± 2.96	0.695
Post-treatment respiratory rate (breaths per minute)	18.0 ± 1.29	18.58 ± 3.1	0.490

*Compared to pretreatment weight, p < 0.001.

Figure 1. Clearance of IS, λFLC, β₂-MG, IL-6, P-cresol, YKL-40, LEP, HPA, TMAO, ADMA, TNF-α and FGF23 following HFR treatment.

Table 2. Comparison of uremic toxin clearance in HFR and HDF treatments.

Toxin (unit)	Clearance rate in HFR (n = 20) (%)	Clearance rate in HDF (n = 20) (%)	p-Value
IS (μg/ml)	59.3 ± 5.9	53.52 ± 17.1	0.161
λFLC (mg/L)	22.9 ± 15.7	15.18 ± 3.9	0.036
β2-MG (μg/L)	16.1 ± 11.1	12.3 ± 3.3	0.042
IL-6 (pg/ml)	74.8 ± 3.5	63.4 ± 19.6	0.041
p-cresol (μg/ml)	67.7 ± 7.5	61.7 ± 15.3	0.152
YKL-40 (pg/ml)	69.8 ± 3.7	64.4 ± 18.2	0.225
LEP (μg/L)	71.7 ± 4.9	62.0 ± 17.1	0.019
HPA (μg/ml)	56.9 ± 7.3	46.0 ± 28.3	0.146
TMAO (mg/L)	55.3 ± 6.0	53.9 ± 16.4	0.700
ADMA (μmol/L)	59.6 ± 6.7	52.8 ± 20.4	0.268
TNF-α (pg/ml)	72.4 ± 4.9	62.5 ± 19.2	0.036
FGF-23 (pg/ml)	71.9 ± 4.2	62.7 ± 21.0	0.111

Abbreviations: IS (indoxyl sulfate); λFLC (λ-free light chains); β₂-MG (β₂-microglobulin); IL-6 (interleukin-6); YKL-40 (chitinase-3-like protein 1); LEP (leptin); HPA (hippuric acid); TMAO (trimethylamine N-oxide); ADMA (asymmetric dimethylarginine); TNF-α (tumor necrosis factor-α); FGF23 (fibroblast growth factor 23).

Table 3. Clearance of serum albumin and branched-chain amino acids in HFR and HDF treatments.

Variables	Pre-HFR (n = 20)	Post-HFR (n = 20)	Pre-HDF (n = 20)	Post-HDF (n = 20)
Serum albumin (g/L)	40.75 ± 5.50	41.30 ± 7.05	48.43 ± 6.16	35.89 ± 6.3*
Valine (mg/L)	8551.0 (6436.75, 9213.75)	1569.0 (1078.0, 9333.0)	6634.5 (1744.75, 9398.0)	1214.5 (1073.25, 7222.75)
Isoleucine (mg/L)	2322.5 (1663.0, 3108.75)	3165.0 (2566.0, 4055.0)	3670.5 (1298.5, 7005.25)	3168.5 (1440.5, 6265.0)

*Compared to pre-HDF, p = 0.000.

Data availability statement

Data are not publicly available due to ethical reasons. Further inquiries can be directed to the corresponding author.