Hemoperfusion Combined with Medium-Cutoff Membrane Dialysis in Patients with End-Stage Renal Disease: Single-Session Reduction Ratios and Associations with Cardiovascular Events

This two-center retrospective cohort study included 344 patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis between January 2019 and January 2024, categorized by modality into an HP+HD group (hemoperfusion combined with medium-cutoff membrane dialysis, n=154) and an HD group (conventional high-flux hemodialysis, n=190). The index date was the start of the assigned modality; follow-up continued to the first composite cardiovascular (CV) event, death, transfer/loss to follow-up, or the study cutoff (31 January 2024).

Patient-level, uncorrected single-session reduction ratios were calculated as (pre-dialysis concentration - post-dialysis concentration)/pre-dialysis concentration x100%. Time to first composite CV event was the primary cardiovascular outcome, analyzed with cumulative-incidence functions and Fine-Gray competing-risk regression (all-cause death as a competing event) and cause-specific Cox regression, stratified by center and adjusted for prior cardiovascular disease, hemoglobin, and age.