Abstract
The objective of this completed, randomized, open-label trial across 11 hemodialysis centers in Shanghai, China, was to evaluate whether hemoadsorption combined with hemodialysis (HAHD) reduces mortality compared to hemodialysis (HD) alone in end-stage kidney disease patients (maintenance HD ≥ 3 months, Kt/V ≥ 1.2). We randomized 1362 patients 1:1 to receive HAHD (n = 683) or HD alone (n = 679; mainly low-flux HD plus intermittent HDF). All 1362 randomized patients were analyzed. The primary outcome was all-cause mortality, while secondary outcomes included cardiovascular mortality and major cardiovascular events. Over a median follow-up of 39.5 months, all-cause mortality occurred in 117 (17.1%) of HAHD patients compared to 144 (21.2%) of HD patients (hazard ratio [HR]: 0.778, 95% confidence interval [CI]: 0.609–0.994; P = 0.045). HAHD also significantly reduced cardiovascular mortality (HR: 0.659, 95% CI: 0.481–0.901; P = 0.009) and major cardiovascular events (HR: 0.772, 95% CI: 0.621–0.959; P = 0.019). Important adverse events, primarily infections and abnormal blood pressure, were comparable between the two groups. Adding hemoadsorption significantly reduced all-cause mortality, cardiovascular mortality, and major cardiovascular events compared to HD alone (mainly low-flux HD plus intermittent HDF). Trial Registration: ClinicalTrials.gov NCT03227770.
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Data availability
The study protocol, including a statistical analysis plan, is available as Supplementary Note in the Supplementary Information. The datasets generated and analyzed during the current study are not publicly available due to institutional and patient privacy regulations but are available from the corresponding author (jianggengru01@xinhuamed.com.cn) for academic research purposes one year after publication. Access is subject to approval by the Ethics Committee of Xinhua Hospital. Requests will be responded to within 20 working days. Requests for access to de-identified data will be reviewed for compliance with data sharing policies and ethical considerations, and approved data will be shared via secure transfer mechanisms. Source data containing the numerical values underlying the survival curves and forest plot are provided with this paper. Source data are provided with this paper.
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Acknowledgements
The authors thank the study participants, trial staff, and investigators for their participation. Principal investigators at the clinical sites are listed below according to the number of patients in each site: Jianzhou Zou, Bo Shen, Zhen Zhang from Zhongshan Hospital, Fudan University; Weiming Zhang, Renhua Lu from Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine; Xiaohua Sheng from Shanghai Sixth People’s Hospital Affiliated to Shanghai JiaoTong University School of Medicine; Haiyang Wu from Shanghai Changhai Hospital; Rong Zhu from Longhua Hospital, Shanghai University of Traditional Chinese Medicine; Jiangtao Li from Tongji Hospital, School of medicine, Tongji University; Xi Chen from Yangpu Hospital, School of Medicine, Tongji University. The HAHD vs HD study was funded by a grant of Shanghai Hospital Development Center (grant No. 16CR1021A).
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W.L. and G.J. conceived and designed the study. W.L. and X.Z. accessed and verified the data, performed statistical analyses, and drafted the initial manuscript. H.H., G.J., Z.G., Y.D., Z.N., R.Z., N.W., C.Y., X.D., Q.Y., Y.W., and X.C. represented the coordinating centers and were responsible for patient recruitment, clinical management, and data collection. The corresponding author (G.J.) had full access to all study data and assumed final responsibility for the decision to submit the manuscript for publication. All authors critically reviewed the manuscript and approved the final version for submission.
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Nature Communications thanks Gonzalo Ramírez-Guerrero, Brendan Smyth, Tom Greene, Haojin Zhou and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. A peer review file is available.
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Lu, W., Zhang, X., Guo, Z. et al. Hemoadsorption combined with hemodialysis versus hemodialysis alone on mortality in end-stage kidney disease: a randomized, open-label, multicenter trial. Nat Commun (2026). https://doi.org/10.1038/s41467-026-71079-7
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DOI: https://doi.org/10.1038/s41467-026-71079-7
