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논문분류	춘계학술대회 초록집
제목	Long-Term Effects of Combined Super High-Flux and Medium-Flux Dialysis on Middle-Molecule Levels and Sleep Quality in Maintenance Hemodialysis: A Prospective Longitudinal Cohort Study
저자	Tran Tuan Tu
출판정보	2026; 2026(1):
키워드	Maintenance hemodialysis, Super high-flux dialyzer, Medium-flux dialyzer, Middle-molecule, Sleep quality
초록	Objectives: Super high-flux (SHF) dialyzers enhance the clearance of middle-molecule solutes, but their long-term use is often limited by cost and availability. This study evaluated the effects of combined SHF and medium-flux (MF) dialyzers on middle-molecule levels and sleep quality in patients undergoing maintenance hemodialysis. Methods: A prospective longitudinal study was conducted in 60 maintenance hemodialysis patients (30 combined SHF–MF and 30 MF alone). The combined SHF–MF group received six SHF (Elisio HX19, Nipro, Japan) and six MF (Elisio 17M, Nipro, Japan) sessions monthly, whereas the MF group received 12 MF sessions. Pre-dialysis hematological parameters and middle-molecule concentrations were measured quarterly, while sleep quality and pruritus were evaluated at baseline and at study completion using the Pittsburgh Sleep Quality Index (PSQI) and the 5-D Itch Scale. Multivariate linear mixed-effects models were applied to examine longitudinal changes and between-group differences across time points. Results: The overall mean age was 55.0 ± 15.2 years, and 60% were male. Longitudinal interactions for hematological parameters and parathyroid hormone levels between groups were not significant. β2-microglobulin levels were significantly lower in the combined SHF–MF group than in the MF-alone group at 6 months (β = -7.45, 95% CI: -10.91 to -3.99, p <0.001) and 9 months (β = -4.09, 95% CI: -7.55 to -0.63, p = 0.022). Combined SHF–MF dialyzers were associated with a significant reduction in PSQI at 9 months compared with MF (β = -2.43, 95% CI: -4.53 to -0.34, p = 0.027), whereas 5-D Itch Scale did not change significantly within and between groups. Conclusion: Combined SHF–MF dialyzers were associated with lower middle-molecule levels and potentially improved sleep quality in maintenance hemodialysis patients, suggesting a feasible approach for resource-limited settings.
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