{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:05:50Z","timestamp":1791864350672,"version":"4.3.4"},"reference-count":26,"publisher":"S. Karger AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Blood Purif"],"abstract":"<jats:p>Introduction: Current guidelines recommend limiting hemoadsorption (HA) duration to 2 h during hemodialysis (HD) sessions due to theoretical concerns about adsorbent saturation and clotting risks. This multicenter prospective cohort study evaluated the long-term safety and efficacy of a novel \u201c4Hs\u201d protocol (4-h HA-HD with blood flow &gt;250 mL\/min). Methods: 78 maintenance HD patients from four centers underwent 26 weeks of 4Hs therapy. Key outcomes included dialysis adequacy (spKt\/V, urea reduction ratio [URR]), uremic toxin (UT) clearance (indoxyl sulfate [IS], p-cresyl sulfate, \u03b22 microglobulin [B2MG]), clotting rates, and adverse events. Statistical comparisons were made against pre-study conventional HA+HD (2-h HA) data using paired t-tests and repeated-measures ANOVA. Results: The 4Hs protocol demonstrated non-inferior safety to conventional HA+HD, with comparable clotting rates (1.79% vs. 1.62%, p = 0.665) and no significant differences in anemia markers or hypoalbuminemia. Dialysis efficacy improved significantly: spKt\/V increased by 0.28 (p = 0.012), URR by 1.18% (p = 0.003), and UT reduction rates (IS: 56.17% vs. 40.14%, p &lt; 0.001; pCS: 47.39% vs. 35.91%, p &lt; 0.001; B2MG: 55.82% vs. 48.41%, p &lt; 0.001). Albumin loss remained comparable between protocols (\u0394 0.5 g\/L, p &gt; 0.05). Conclusion: Extending HA duration to 4 h with high-flow hemodynamics (Qb &gt;250 mL\/min) is safe and enhances toxin clearance without increasing clotting risks. These findings challenge current SOP limitations on HA duration and support protocol optimization in maintenance HD patients. <\/jats:p>","DOI":"10.1159\/000545988","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T12:01:40Z","timestamp":1745236900000},"page":"413-423","source":"Crossref","is-referenced-by-count":9,"title":["Long-Term Safety of \u201c4-Hour\u201d Hemoadsorption Combined with Hemodialysis in Maintenance Hemodialysis Patients: A Multicenter Prospective Cohort Study"],"prefix":"10.1159","volume":"54","author":[{"given":"Dongliang","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuiping","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingxin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyang","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjun","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2025,4,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.24875\/RIC.23000223"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1159\/000525952"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1159\/000514187"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.22713"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1159\/000527453"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.5301\/IJAO.2011.7748"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1159\/000514187"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000006160"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1177\/0391398819837546"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-9987.2011.00937.x"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1159\/000525225"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/6739762"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfae266"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1159\/000489921"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.3390\/toxins13040246"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-04009-w"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/aor.13480"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1159\/000500014"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02660221"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12246"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.5152\/tjg.2018.17415"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1159\/000534906"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1159\/000539396"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1111\/aor.14161"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1177\/039139889301601207"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.21037\/atm-21-1100"}],"container-title":["Blood 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