Perfluoroalkyl substance levels are associated with filter type and nutritional status in hemodialysis patients

Per- and polyfluoroalkyl substances (PFASs) are persistent environmental pollutants linked to adverse health outcomes, notably kidney disease. This study examines the effects of hemodialysis and dialysis membrane characteristics on the clearance of eight specific PFASs in patients undergoing hemodialysis. A cohort of 301 chronic hemodialysis patients, each treated for a minimum of 90 days, was analyzed. Automated column-switching ultra-performance liquid chromatography-tandem mass spectrometry was utilized to detect the PFASs, and multivariable linear regression models assessed the association between PFAS levels and clinical nutritional biochemistry markers. Results revealed significantly lower PFAS concentrations in the FILTRYZER dialyzer membrane compared to Polyamix, with no notable differences across varying membrane surface areas. Moreover, significant correlations were observed between nutritional markers-such as albumin, uric acid, and the normalized protein catabolic rate-and the levels of perfluoroheptanoic acid (PFHpA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA). The findings indicate that PFAS levels in hemodialysis patients are influenced by the membrane composition and properties but are unaffected by the surface area of the membranes.