the Impact of Hemodialysis Combined with Hemoperfusion on Metabolism, Cytokines, and Novel Biomarkers in Chronic Kidney Disease Patients
Inflammation, Metabolism, and Biomarkers in CKD
Abstract
Background: Chronic kidney disease (CKD) often progresses to end-stage renal disease (ESRD), severely affecting patients' lives.
Objectives: This article explored the effects of hemodialysis (HD) combined with hemoperfusion (HP) on metabolic indicators, inflammatory cytokines, and novel biomarkers—including oxidative stress markers (malondialdehyde, MDA; superoxide dismutase, SOD), vascular endothelial markers (endothelin-1, ET-1), fibrosis markers (transforming growth factor-beta1, TGF-β1), and metabolic risk markers (homocysteine, Hcy)—in CKD patients.
Methods: A retrospective analysis was conducted on clinical data from 72 CKD patients admitted to Changxing County Hospital of Traditional Chinese Medicine from October 2023 to October 2025. Patients were divided into HD+HP group (AG, n=35) and HD group (BG, n=37). Changes in metabolic indicators, inflammatory factors, and novel biomarkers before and after 6 months of treatment were compared.
Results: After treatment, the AG showed markedly lower levels of BUN, Scr, iPTH, and β₂-MG compared to the BG (P < 0.05), with a 42.3% reduction in iPTH (326.7 ± 58.4 pg/mL vs. 566.2 ± 89.1 pg/mL). The AG also had markedly lower levels of IL-6, TNF-α, and hs-CRP (P < 0.01). Novel biomarkers including MDA, ET-1, TGF-β1, and Hcy were significantly lower in AG post-treatment (P < 0.05), with SOD activity significantly increased. No visible distinction was noted in adverse event rates (P > 0.05).
Conclusion: HD combined with HP can more effectively remove medium and large molecular toxins, improve oxidative stress, endothelial function, and fibrosis markers, and markedly improve calcium-phosphorus metabolism disorders and micro-inflammatory status, providing comprehensive clinical evidence for optimizing blood purification strategies.
References
2. Graterol Torres F, Molina M, Soler-Majoral J, Romero-González G, Rodríguez Chitiva N, Troya-Saborido M, et al. Evolving concepts on inflammatory biomarkers and malnutrition in chronic kidney disease. Nutrients. 2022;14(20):4297.
3. Gao L, Zhang J, Yang T, Jiang L, Liu X, Wang S, et al. STING/ACSL4 axis-dependent ferroptosis and inflammation promote hypertension-associated chronic kidney disease. Mol Ther. 2023;31(10):3084-103.
4. Hartomuljono A, Sugiarto A, Jennefer J. Hemoperfusion techniques using Jafron HA330 cartridge combined with BBraun Dialog+ dialysis machine in patient with coronavirus disease 2019 pneumonia and septic shock: a case report. J Med Case Rep. 2023;17(1):156.
5. Wilkinson TJ, McAdams-DeMarco M, Bennett PN, Wilund K (Global Renal Exercise Network). Advances in exercise therapy in predialysis chronic kidney disease, hemodialysis, peritoneal dialysis, and kidney transplantation. Curr Opin Nephrol Hypertens. 2020;29(5):471-9.
6. Mori K. Maintenance of skeletal muscle to counteract sarcopenia in patients with advanced chronic kidney disease and especially those undergoing hemodialysis. Nutrients. 2021;13(5):1538.
7. Jha V, Al-Ghamdi SMG, Li G, Wu MS, Stafylas P, Retat L, et al. Global economic burden associated with chronic kidney disease: a pragmatic review of medical costs for the inside CKD research programme. Adv Ther. 2023;40(10):4405-20.
8. Kaneko S, Yamagata K. Hemodialysis-related amyloidosis: Is it still relevant? Semin Dial. 2018;31(6):612-8.
9. Kadatane SP, Satariano M, Massey M, Mongan K, Raina R. The role of inflammation in CKD. Cells. 2023;12(12):1581.
10. Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH, et al. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021;99(3):559-69.
11. Ronco C. Combined hemoperfusion-hemodialysis in end-stage renal disease patients. Contrib Nephrol. 2023;200:118-22.
12. Vulugundam SC, Kiranmayi VS, Rao PVLNS, Vishnubhotla SK. Hepatocyte growth factor in predialysis and hemodialysis chronic kidney disease patients. Saudi J Kidney Dis Transpl. 2022;33(1):58-65.
13. Oshima Y, Tanaka A, Fukuki M, Otsuki A, Hisatome I. A case of high-dose intravenous MgSO4 and hemoperfusion for aconite poisoning with chronic kidney disease. Yonago Acta Med. 2024;67(3):270-9.
14. Wang J, Luo Y, Ji X, Xu H, Liang Z, Zhou M. Effects of different hemodialysis modalities combined with low-calcium dialysate on mineral metabolism and vascular calcification in maintenance hemodialysis patients with chronic kidney disease. J Appl Biomed. 2024;22(4):228-33.
15. Ammirati AL. Chronic kidney disease. Rev Assoc Med Bras. 2020;66(Suppl 1):s03-s09.
16. Evans M, Lewis RD, Morgan AR, Whyte MB, Hanif W, Bain SC, et al. A narrative review of chronic kidney disease in clinical practice: current challenges and future perspectives. Adv Ther. 2022;39(1):33-43.
17. Small DM, Coombes JS, Bennett N, Johnson DW, Gobe GC. Oxidative stress, anti-oxidant therapies and chronic kidney disease. Nephrology (Carlton). 2012;17(4):311-21.
18. Lv W, Wang X, Li X, Wang Y, Li Z, Qin W, et al. The role of oxidative stress and inflammation in CKD progression. Oxid Med Cell Longev. 2021;2021:6651617.
19. Suryantoro SD, Ardhany AR, Basoeki W, Thaha M, Mardiana N, Tjempakasari A, et al. Dietary management of haemodialysis patients with chronic kidney disease and malnourishment. Asia Pac J Clin Nutr. 2021;30(4):579-87.
20. Fu EL, Evans M, Carrero JJ, Putter H, Clase CM, Caskey FJ, et al. Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study. BMJ. 2021;375:e066306.
21. Yang C, Diao L, Song Z, Guan C, Xu L, Bu Q, et al. Mesoporous activated carbon derived from Chinese herbal medicine residues for hemoperfusion removal of uremia toxins from progressive chronic kidney diseases patients. Heliyon. 2024;10(20):e38892.
22. Gu L, Xia Z, Qing B, Wang W, Chen H, Wang J, et al. Systemic inflammatory response index (SIRI) is associated with all-cause mortality and cardiovascular mortality in population with chronic kidney disease: evidence from NHANES (2001-2018). Front Immunol. 2024;15:1338025.
23. Dounousi E, Papavasiliou E, Makedou A, Ioannou K, Katopodis KP, Tselepis A, et al. Oxidative stress is progressively enhanced with advancing stages of CKD. Am J Kidney Dis. 2006;47(5):793-802.
24. Cao Y, Li Y, Wang H, Ji C, Chen C, Wang D. Elevated endothelin-1 is an independent predictor of cardiovascular events in hemodialysis patients. J Am Heart Assoc. 2019;8(14):e011975.
25. Meng XM, Nikolic-Paterson DJ, Lan HY. TGF-β: the master regulator of fibrosis. Nat Rev Nephrol. 2016;12(6):325-38.
26. van Guldener C, Janssen MJ, Lambert J, Steyn M, Donker AJ, Stehouwer CD. Endothelium-dependent vasodilatation is impaired in peritoneal dialysis patients. Nephrol Dial Transplant. 2003;18(3):563-8.
27. Li J, Li D, Xu Y, Wang A, Xu C, Yu C. The optimal timing of hemoperfusion component in combined hemodialysis-hemoperfusion treatment for uremic toxins removal. Ren Fail. 2015;37(1):103-7.
28. Lu W, Ren C, Han X, Yang X, Cao Y, Huang B. The protective effect of different dialysis types on residual renal function in patients with maintenance hemodialysis: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(37):e12325.
29. Puspitasari M, Hidayat ARP, Wijaya W, Wardhani Y, Sattwika PD, Jonny J, et al. Effectiveness of combined hemodialysis-hemadsorption therapy in improving uremic toxin clearance, inflammatory markers, and symptoms in maintenance hemodialysis patients. Blood Purif. 2024;53(9):732-42.
30. Zhang Y, Mei CL, Rong S, Liu YY, Xiao GQ, Shao YH, et al. Effect of the combination of hemodialysis and hemoperfusion on clearing advanced glycation end products: a prospective, randomized, two-stage crossover trial in patients under maintenance hemodialysis. Blood Purif. 2015;40(2):127-32.
Copyright (c) 2026 Ming Cai
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.