Objective:

To investigate the effects of combining hemoperfusion with high-flux hemodialysis on T lymphocyte subsets, mitochondrial health, and clinical outcomes in maintenance hemodialysis patients, focusing on primary outcomes such as immune function and quality of life.

Key Findings:

• Significant decrease in protein-bound uremic toxins (indoxyl sulphate and p-cresyl sulphate) immediately after hemoperfusion (p < 0.001), with implications for toxin management.
• After 12 sessions, increases in T lymphocyte subsets (CD3+, CD4+, CD8+) and mitochondrial membrane potential were observed (all p < 0.05), indicating enhanced immune function.
• Patients reported significant improvements in sleep quality, uremic pruritus, and overall quality of life (all p < 0.01), highlighting the treatment's impact on patient well-being.
• Serum phosphorus and parathyroid hormone levels were significantly reduced after the treatment period, suggesting metabolic benefits.

Interpretation:

The observed increases in immune-related parameters and improvements in patient-reported outcomes suggest potential benefits of combined hemoperfusion and high-flux dialysis, although the mechanism behind these improvements remains unclear and warrants further exploration.

Limitations:

• Pre-dialysis levels of protein-bound uremic toxins were not significantly different from baseline after the last session, indicating a need for alternative explanations for observed benefits.
• The study's single-arm, observational design limits the ability to draw definitive conclusions and requires further validation through randomized controlled trials, highlighting potential biases.

Conclusion:

The combination of hemoperfusion and high-flux dialysis may enhance immune function and quality of life in hemodialysis patients, warranting further investigation into the mechanisms and long-term effects.