Multifaceted benefits of regular hemoperfusion in maintenance hemodialysis: A propensity score-matched study

Abstract

Hemoperfusion (HP) is proposed to remove middle molecules inadequately cleared by conventional dialysis, yet its comprehensive benefits across multiple uremic complications remain underexplored. In this propensity score-matched retrospective cohort study of 184 maintenance hemodialysis patients, we compared outcomes between 35 patients receiving regular weekly HP and 35 receiving irregular HP (⩽3 times/year) over 2 years. The regular HP group achieved similar blood pressure control (80.0% vs 74.3%) but with significantly lower antihypertensive medication burden (score: 1.9 vs 3.1, p < 0.001). They also demonstrated superior mineral bone disease management, with lower iPTH (288.5 vs 412.3 pg/mL, p < 0.001) and phosphate levels (1.52 vs 1.83 mmol/L, p = 0.002), higher composite target achievement (62.9% vs 42.9%, p = 0.048), and reduced need for phosphate binders and active vitamin D. Notably, regular HP dramatically reduced uremic pruritus requiring medication (gabapentin: 14.3% vs 80.0%, p < 0.001) and dialysis-related encephalopathy (2.9% vs 20.0%, p = 0.024). No increased safety risks were observed. Regular HP offers comprehensive benefits, improving management of hypertension and mineral bone disease while dramatically reducing pruritus and encephalopathy risk, all with a favorable safety profile.