Abstract: Objective To explore the efficacy of different blood purification methods on intradialytic hypotension (IDH) and the changes of cardiac structure and function in maintenance hemodialysis (MHD) patients. Methods Thirty IDH patients were randomly divided into hemodialysis (HD) group (n=10), hemodiafiltration combined with hemodialysis (HDF+HD) group (n=10), hemoperfusion combined with hemodialysis (HP+HD) group (n=10), and they were observed for 24 weeks. ①The changes of blood pressure in hemodialysis sessions and the frequency of IDH were compared between the 3 groups. ②Serum parathyroid hormone (PTH), NT-probrain natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hs-CRP) were measured before and after the treatment for 24 weeks. ③Left ventricular diastolic diameter (LVDd), interventricular septal thickness (IVST) and left ventricular ejection fraction (LVEF) were examined by echocardiography after the treatment for 24 weeks. Results ①The frequency of IDH was significantly lower in HDF+HD and HP+HD groups than in HD group (χ2=510.693, P=0.001). ②Serum PTH, NT-proBNP, Hs-CRP levels decreased significantly in HP+HD and HDF+HD groups after the treatment for 24 weeks as compared with those before treatment (for HD group: t1=0.304, P1=0.761; t2=0.401, P2=0.748; t3=0.312, P3=0.756; for HDF+HD group: t1=4.780, P1＜0.001; t2=4.813, P2＜0.001; t3=3.950, P3＜0.001; for HP+HD group: t1=4.586, P1＜0.001; t2=4.802, P2＜0.001; t3=3.961, P3＜0.001), and were lower in HP+HD and HDF+HD groups than in HD group after the treatment for 24 weeks (for PTH: F=3.161, P=0.017; for NT-proBNP: F=4.130, P=0.021; for Hs-CRP: F=3.100, P= 0.015). ③LVEF increased significantly in HDF+HD and HP+HD groups after the treatment for 24 weeks as compared with that in HD group (F=6.926, P= 0.002). Conclusion HP+HD and HDF+HD were better than HD for the improvement of cardiac function and hemodynamic stability in IDH patients. HP+HD and HDF+HD may be used as a long-term therapy for IDH patients.

Key words: hemodiafiltration, hemoperfusion, intradialytic hypotension, Cardiac structure, Cardiac function