Hemoadsorption and Hemodialysis in ESKD

Key Takeaways

• In end-stage kidney disease, hemoadsorption plus hemodialysis was associated with lower all-cause mortality than hemodialysis alone during follow-up.
• Cardiovascular mortality and major cardiovascular events were also lower with the combined strategy.
• Adverse events considered potentially treatment-related were reported at broadly comparable rates between groups.

Adults with end-stage kidney disease receiving maintenance hemodialysis had lower all-cause mortality when hemoadsorption was added in a randomized open-label multicenter trial. The primary analysis showed a hazard ratio of 0.778 for death from any cause, with a 95% confidence interval of 0.609 to 0.994.

After a 1-month washout period, 1,362 eligible participants were randomized 1:1 across 11 hemodialysis centers in Shanghai. The study assigned 683 patients to hemoadsorption plus hemodialysis and 679 to hemodialysis alone. Eligible adults had end-stage kidney disease, had received maintenance hemodialysis for at least 3 months, and had a standard Kt/V of at least 1.2. Median age was 61 years, and 62.2% were male.

In the intervention arm, investigators used an HA130 cartridge placed in series before the filter during routine dialysis sessions. Hemoadsorption was scheduled at least once every two weeks, and the cartridge remained in use for the first 2 hours. Blood flow was 150 to 200 mL/min during hemoadsorption, then 200 to 250 mL/min after the cartridge was discontinued. Cartridges were primed with 12,500 IU heparin and 2,000 to 3,000 mL saline, while the comparator regimen was mainly low-flux hemodialysis plus intermittent hemodiafiltration.

Over a median follow-up of 39.5 months, all-cause mortality occurred in 117 of 683 patients, or 17.1%, in the combined group and 144 of 679, or 21.2%, with hemodialysis alone. The corresponding hazard ratio was 0.778, with a 95% confidence interval of 0.609 to 0.994 and P=0.045. Cardiovascular mortality occurred in 66 of 683 patients, or 9.66%, versus 97 of 679, or 14.3%, with a hazard ratio of 0.659, a 95% confidence interval of 0.481 to 0.901, and P=0.009. Major cardiovascular events were also lower, with a hazard ratio of 0.772, a 95% confidence interval of 0.621 to 0.959, and P=0.019.

Important adverse events considered potentially treatment-related were reported in 47 of 683 patients, or 6.88%, with hemoadsorption and 64 of 679, or 9.42%, in control. These events mainly involved infections and abnormal blood pressure, and serious treatment-related reactions included two bleeding episodes and one abnormal blood pressure event with hemoadsorption and two infections in control.