Abstract:

Ｏｂｊｅｃｔｉｖｅ：To compare the efficiency of proteinbound uraemic toxins removal by four main strategies [lowflux hemodialysis (LFHD),highflux hemodialysis (HFHD),hemodiafiltration (HDF) and hemoperfusion(HD+HP).]
Ｍｅｔｈｏｄｏｌｏｇｙ：This study was a prospective,randomized clinical trial.136 maintenance hemodialysi(MHD) patients were selected and after four weeks of runin period they were randomly divided into four groups:LFHD group,HFHD group,HDF group and HD+HP group.Removal of hippuric acid(HA),pcresyl sulfate (PCS),indoxyl sulfate (IS) and 3carboxy4methyl5propyl2furanpropionic acid(CMPF) was determined by reduction ratios (RRs) and total solute removal (TSR) in continuously collected dialysate and HD+HP apparatus by highperformance liquid chromatography tandem mass spectrometry(HPLCMS/MS).
Ｒｅｓｕｌｔｓ：Plasma levels of the proteinbound toxins were significantly decreased by all treatment forms,but the removal effective were different.As for HA,the reduction rate were no difference in each group (P>005).As for PCS,HDF and HD+HP have higher RR than LFHD (P<001) and HFHD (P<005,P<001).As for IS,HDF and HD+HP have higher RR than LFHD (P<005) and HFHD (P<005). CMPF can hardly remove in LFHD and HFHD,while HDF and HD+HP have higher RR than LFHD (P<001) and HFHD (P<001). And HD+HP was higher than HDF (P<001)
Ｃｏｎｃｌｕｓｉｏｎ：The  remove efficacy of  low affinity to human serum albumin proteinbound toxin were not significant different among groups. To remove middle affinity to human serum albumin proteinbound toxins,HDF and HD+HP were superior to HFHD and LFHD. To remove high affinity to human serum albumin proteinbound toxins,HDF and HD+HP can be partially removed,and HD+HP is the best. While HFHD and LFHD were hardly to remove.