biostudies-literatureLu Rthe Crosswise projects of Renji Hospital, School of Medicine, Shanghai Jiao Tong Universitythe Clinical Research Plan of SHDC2338929https://www.ebi.ac.uk/biostudies/studies/S-EPMC11028005biostudies-literatureUnknown46(1)<h4>Objective</h4>To delineate the efficacy and safety profile of hemodiafiltration with endogenous reinfusion (HFR) for uremic toxin removal in patients undergoing maintenance hemodialysis (MHD).<h4>Methods</h4>Patients who have been on MHD for a period of at least 3 months were enrolled. Each subject underwent one HFR and one hemodiafiltration (HDF) treatment. Blood samples were collected before and after a single HFR or HDF treatment to test uremic toxin levels and to calculate clearance rate. The primary efficacy endpoint was to compare uremic toxin levels of indoxyl sulfate (IS), λ-free light chains (λFLC), and β₂-microglobulin (β₂-MG) before and after HFR treatment. Secondary efficacy endpoints was to compare the levels of urea, interleukin-6 (IL-6), P-cresol, chitinase-3-like protein 1 (YKL-40), leptin (LEP), hippuric acid (HPA), trimethylamine N-oxide (TMAO), asymmetric dimethylarginine (ADMA), tumor necrosis factor-α (TNF-α), fibroblast growth factor 23 (FGF23) before and after HFR treatment. The study also undertook a comparative analysis of uremic toxin clearance between a single HFR and HDF treatment. Meanwhile, the lever of serum albumin and branched-chain amino acids before and after a single HFR or HDF treatment were compared. In terms of safety, the study was meticulous in recording vital signs and the incidence of adverse events throughout its duration.<h4>Results</h4>The study enrolled 20 patients. After a single HFR treatment, levels of IS, λFLC, β₂-MG, IL-6, P-cresol, YKL-40, LEP, HPA, TMAO, ADMA, TNF-α, and FGF23 significantly decreased (<i>p</i> < 0.001 for all). The clearance rates of λFLC, β₂-MG, IL-6, LEP, and TNF-α were significantly higher in HFR compared to HDF (<i>p</i> values: 0.036, 0.042, 0.041, 0.019, and 0.036, respectively). Compared with pre-HFR and post-HFR treatment, levels of serum albumin, valine, and isoleucine showed no significant difference (<i>p</i> > 0.05), while post-HDF, levels of serum albumin significantly decreased (<i>p</i> = 0.000).<h4>Conclusion</h4>HFR treatment effectively eliminates uremic toxins from the bloodstream of patients undergoing MHD, especially protein-bound toxins and large middle-molecule toxins. Additionally, it retains essential physiological compounds like albumin and branched-chain amino acids, underscoring its commendable safety profile.Renal failureHemodiafiltration with endogenous reinfusion for uremic toxin removal in patients undergoing maintenance hemodialysis: a pilot study.PMC11028005IIT-2023-0070SHDC2020CR4004Fang YQian YXie YGu LZeng XWu WLiu TZhou YLu RfalseHemodiafiltration with endogenous reinfusion for uremic toxin removal in patients undergoing maintenance hemodialysis: a pilot study.<h4>Objective</h4>To delineate the efficacy and safety profile of hemodiafiltration with endogenous reinfusion (HFR) for uremic toxin removal in patients undergoing maintenance hemodialysis (MHD).<h4>Methods</h4>Patients who have been on MHD for a period of at least 3 months were enrolled. Each subject underwent one HFR and one hemodiafiltration (HDF) treatment. Blood samples were collected before and after a single HFR or HDF treatment to test uremic toxin levels and to calculate clearance rate. The primary efficacy endpoint was to compare uremic toxin levels of indoxyl sulfate (IS), λ-free light chains (λFLC), and β₂-microglobulin (β₂-MG) before and after HFR treatment. Secondary efficacy endpoints was to compare the levels of urea, interleukin-6 (IL-6), P-cresol, chitinase-3-like protein 1 (YKL-40), leptin (LEP), hippuric acid (HPA), trimethylamine N-oxide (TMAO), asymmetric dimethylarginine (ADMA), tumor necrosis factor-α (TNF-α), fibroblast growth factor 23 (FGF23) before and after HFR treatment. The study also undertook a comparative analysis of uremic toxin clearance between a single HFR and HDF treatment. Meanwhile, the lever of serum albumin and branched-chain amino acids before and after a single HFR or HDF treatment were compared. In terms of safety, the study was meticulous in recording vital signs and the incidence of adverse events throughout its duration.<h4>Results</h4>The study enrolled 20 patients. After a single HFR treatment, levels of IS, λFLC, β₂-MG, IL-6, P-cresol, YKL-40, LEP, HPA, TMAO, ADMA, TNF-α, and FGF23 significantly decreased (<i>p</i> < 0.001 for all). The clearance rates of λFLC, β₂-MG, IL-6, LEP, and TNF-α were significantly higher in HFR compared to HDF (<i>p</i> values: 0.036, 0.042, 0.041, 0.019, and 0.036, respectively). Compared with pre-HFR and post-HFR treatment, levels of serum albumin, valine, and isoleucine showed no significant difference (<i>p</i> > 0.05), while post-HDF, levels of serum albumin significantly decreased (<i>p</i> = 0.000).<h4>Conclusion</h4>HFR treatment effectively eliminates uremic toxins from the bloodstream of patients undergoing MHD, especially protein-bound toxins and large middle-molecule toxins. Additionally, it retains essential physiological compounds like albumin and branched-chain amino acids, underscoring its commendable safety profile.2024-01-01T00:00:00Z2024 Dec2026-06-01T21:19:48.213Z2026-05-21T03:08:10.356ZS-EPMC110280053863296310.1080/0886022X.2024.2338929