On Aug 11, 2022, "Randomized Control Study on Hemoperfusion Combined with Hemodialysis versus Standard Hemodialysis: Effects on Middle-Molecular-Weight Toxins and Uremic Pruritus" was published in the journal Blood Purification. The study, organized by Academician Chen Xiangmei from the Chinese Academy of Engineering, sees a breakthrough in the multi-center studies of the Jafron HA130 disposable hemoperfusion cartridge.

It is the world's first multi-center study about hemoperfusion in Chinese chronic hemodialysis (HD) patients. The four-year-long study, coming from the cooperation among numerous researchers in 37 clinical medical centers, is of great importance considering the surging cases of end-stage kidney disease (ESKD) and the constraints and obstacles of the traditional treatment technology. 

ESKD is the last stage (stage five) of chronic kidney disease (CKD), which means kidneys only function at 10 to 15 percent of their normal capacity. Patients suffering from that can only rely on Renal replacement therapy (RRT) like HD, kidney transplantation, and peritoneal dialysis to survive. 

Recent years have seen a surge in ESKD cases and the incidence of EKSD-related symptoms, from 234,632 cases in 2011 to over 800 thousand in 2021 in China side; According to an essasy published in 2019, the global estimated prevalence of CKD is 13.4% (11.7-15.1%), and patients with ESKD needing renal replacement therapy is estimated between 4.902 and 7.083 million. Therefore, ESKD is considered to have serious implications for public health. While for its treatment, traditional HD cannot remove the toxin, like middle and large molecule uremic toxins and protein-bound uremic toxins (PBUT) completely because of the restriction of membrane separation technology, whose accumulation will lead to various kinds of complications. 

Fortunately, hemoperfusion (HP) can break the constraint of the technology, strengthening the scavenging effect on the toxins. It is an extracorporeal blood purification modality that consists of the passage of anticoagulated whole blood through a device, usually a column, that contains adsorbent particles. HP is used for the removal of toxins in poisonings and cytokines from septic and inflamed patients. An increasing range of pathogens and molecules can also be removed with novel devices, making it a potential supplementary to traditional treatments. So, what will happen if we combine HP with HD?

Driven by the growing severity of ESKD and the novel method, Mrs. Chen and her team have rolled out a series of full open Randomized Controlled Trials (RCT) with multi-centers to seek the effect of HA130 hemoperfusion combined with HD on the toxins and uremic pruritus.

The results of the four-year studies on 438 patients, who were separated into four groups for RCT, revealed that HA130 hemoperfusion with HD can lower Beta-2 microglobulin（β2M）and parathyroid hormone (PTH) levels and reduce the symptoms of uremic pruritus. So it can be a novel blood purification method for ESKD patients. Besides, the research also tells that the joining of Jafron HA130 in the treatment can alleviate the complication caused by the accumulation of uremic toxins. Its early application can be another possible prevention from the pertinent complications.

The value of the research is approved by Claudio Ronco, director of the Department of Nephrology. In his editorial commentary "The Promise of Adsorption for Chronic Dialysis Patients" in the journal Blood Purification, he made a comment on its effect: “Due to its specific blood cleansing mechanism, hemoperfusion can overcome the limitations imposed by dialysis membranes and achieve an effective removal of a wider spectrum of solutes” and concluded, “We have a remarkable research agenda, but this is the basis of scientific progress and the rigorous methodology for technological advancement.”

The applause from all the researchers and professors is the booster of our confidence, and Jafron believes the HP(HA130)+HD therapy can be a prospective treatment for ESKD patients. The further improvement of hemoperfusion technology would be an engine for fighting against the threats to public health. 

Reference

[1] what is ESKD, available at:

https://www.davita.com/education/kidney-disease/stages/what-is-end-stage-renal-disease

[2] Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Adv Exp Med Biol. 2019;1165:3-15. doi: 10.1007/978-981-13-8871-2_1. PMID: 31399958. 

[3] what is RRT, available at:  

https://en.wikipedia.org/wiki/Renal_replacement_therapy

[4] what is HP, available at:

https://www.uptodate.com/contents/hemoperfusion

[5] ESKD in the US, available at:

https://www.cdc.gov/mmwr/volumes/71/wr/mm7111a3.htm

[6] Ibrahim MAA, ElHakim IZ, Soliman D, Mubarak MA, Said RM. Online hemodiafilteration use in children: a single center experience with a twist. BMC Nephrol. 2020 Jul 28;21(1):306. doi: 10.1186/s12882-020-01957-9. PMID: 32723294; PMCID: PMC7388526.

[7] Ronco C: The Promise of Adsorption for Chronic Dialysis Patients. Blood Purif 2022. doi: 10.1159/000525953