Efficacy of pHA130 Hemoadsorption for 4 Hours (p4H Study)

Comparison of the Efficacy of Hemoadsorption Combined With Hemodialysis of Different Treatment Durations in Clearing Protein-Bound Uremic Toxins: A Randomized Crossover Controlled Trial

This is an open-label, randomized, crossover study to evaluate the efficacy of extending the duration of hemoadsorption (HA) combined with hemodialysis (HD) from 2 hours to 4 hours for clearing protein-bound uremic toxins, such as Indoxyl Sulfate (IS), in stable maintenance hemodialysis patients. Patients will be randomized to receive either 2-hour HA or 4-hour HA once a week for 8 weeks, then cross over to the other treatment for another 8 weeks after a 2-week washout period. The primary endpoint is the reduction rate of IS.

Patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) have a high burden of uremic toxins, particularly protein-bound uremic toxins (PBUTs), which are poorly cleared by conventional dialysis and are associated with high cardiovascular mortality. hemoadsorption (HA) is an adjunctive blood purification technique effective at removing PBUTs. The standard duration for HA sessions is typically 2-2.5 hours. However, emerging evidence suggests that extending the treatment duration may enhance toxin removal. This study aims to rigorously compare the efficacy and safety of a 4-hour HA session combined with hemodialysis against a standard 2-hour session in clearing key PBUTs like Indoxyl Sulfate (IS) and p-Cresyl Sulfate (PCS). The findings will provide crucial evidence for optimizing HA treatment protocols to improve toxin clearance and potentially patient outcomes in the ESRD population.

Inclusion Criteria:

• Age between 18 and 75 years, regardless of gender
• Stable maintenance hemodialysis for ≥3 months, with a relatively fixed dialysis regimen
• Receiving hemodialysis 3 times per week, each session lasting ≥4 hours
• Single-pool Kt/V (spKt/V) ≥1.2 within 8 weeks prior to enrollment
• Willing and able to sign the informed consent form

Exclusion Criteria:

• Life expectancy less than 1 year
• White blood cell count < 4 × 10⁹/L and/or platelet count < 60 × 10⁹/L
• Active or chronic gastrointestinal bleeding, or diagnosed coagulation disorders
• Active malignant tumor
• Active infection
• Pregnant or breastfeeding
• Participation in another clinical trial within the past month or currently enrolled in one
• Deemed unsuitable for the study by the investigator