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Many hypotheses could explain the mortality decrease observed using hemodiafiltration, such as reduction of intradialytic hypotension and more efficient toxin removal. We led a systematic analysis of representative uremic toxin removal with hemodialysis (HD), online postdilution hemodiafiltration (postHDF) and online predilution hemodiafiltration (preHDF), in a single-center crossover and prospective observational study. The primary outcome was the reduction ratio of uremic toxins of the three categories defined by the Eutox group. Twenty-six patients were treated by those three techniques of extra renal epuration. Mean Kt/Vurea was not different between the treatment methods. Mean reduction ratio of beta2microglobulin was significantly higher for both HDF treatments than for HD (p < 0.001). Myoglobin, kappa, and lambda free light chain reduction ratio was significantly different between the modes: 37.75 ± 11.95%, 45.31 ± 11% and 61.22 ± 10.56%/57.21 ± 12.5%, 63.53 ± 7.93%, and 68.40 ± 11.79%/29.12 ± 8.44%, 34.73 ± 9.01%, and 45.55 ± 12.31% HD, preHDF, and postHDF, respectively (p < 0.001). Mean protein-bound solutes reduction ratio was not different between the different treatments except for PCS with a higher reduction ratio during HDF treatments. Mean albumin loss was always less than 2 g. HDF improved removal of middle molecules but had no effect on indoles concentration without any difference between synthetic dialysis membranes. [ABSTRACT FROM AUTHOR]

Many hypotheses could explain the mortality decrease observed using hemodiafiltration, such as reduction of intradialytic hypotension and more efficient toxin removal. We led a systematic analysis of representative uremic toxin removal with hemodialysis (HD), online postdilution hemodiafiltration (postHDF) and online predilution hemodiafiltration (preHDF), in a single-center crossover and prospective observational study. The primary outcome was the reduction ratio of uremic toxins of the three categories defined by the Eutox group. Twenty-six patients were treated by those three techniques of extra renal epuration. Mean Kt/Vurea was not different between the treatment methods. Mean reduction ratio of beta2microglobulin was significantly higher for both HDF treatments than for HD (p < 0.001). Myoglobin, kappa, and lambda free light chain reduction ratio was significantly different between the modes: 37.75 ± 11.95%, 45.31 ± 11% and 61.22 ± 10.56%/57.21 ± 12.5%, 63.53 ± 7.93%, and 68.40 ± 11.79%/29.12 ± 8.44%, 34.73 ± 9.01%, and 45.55 ± 12.31% HD, preHDF, and postHDF, respectively (p < 0.001). Mean protein-bound solutes reduction ratio was not different between the different treatments except for PCS with a higher reduction ratio during HDF treatments. Mean albumin loss was always less than 2 g. HDF improved removal of middle molecules but had no effect on indoles concentration without any difference between synthetic dialysis membranes.

[Display omitted] • Two-dimensional borocarbonitrides (BCN) nanosheets with B and N heteroatoms co-doping proved to be promising as adsorbents for blood purification. • The as-fabricated B-PES microspheres delivered considerable adsorption capacities on creatinine, uric acid and bilirubin. • In simulated perfusion, B-PES microspheres showed outstanding toxin removal efficiency experiments even at a high perfusion rate. • The used B-PES microspheres can be rapidly regenerated and recycled by fast-drying through photothermal effect. Adsorbents, which can be used to directly eliminate uremic toxins from blood, are decisive for hemoperfusion that maintains human renal function. However, developing adsorbents with large adsorption capacity, excellent chemical stability, high hemocompatibility and good cyclicity for toxins is still challenging. Herein, we proposed a type of two-dimensional (2D) carbon materials-borocarbonitrides (BCN) nanosheets as a novel uremic toxin adsorbent for blood perfusion. Theoretical analysis firstly confirmed the stronger binding capacity of BCN layer towards small molecular toxins than that of graphene. To make it applicable for practical perfusion, BCN nanosheets engineered sulfonated polyether sulfone (SPES) microspheres (B-PES) are thus constructed. Through static adsorption, the B-PES-4 achieves effective toxin adsorption capacities of 26, 40 and 197 mg g−1 on creatinine, uric acid and bilirubin respectively, which are 550%, 508% and 1756% outperforming pure SPES microspheres. In addition, simulated perfusion experiments demonstrate a good toxin removal efficiency for the microspheres, for example, over 80% of bilirubin is removed at a high perfusion rate of 20 mL min−1. Moreover, the B-PES microspheres neither induce hemolysis and immunoreaction in the blood nor affect cell viability. As a proof of concept, the photothermal property of BCN nanosheets is innovatively exploited for fast-drying and efficient recycling of the used B-PES microspheres. These features, together with the reusability, blood and cell compatibility, make the platform highly promising for clinical blood purification and artificial kidney application. [ABSTRACT FROM AUTHOR]