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Background Online hemodiafiltration (OL-HDF), whether in pre-dilution OL-HDF (pre-HDF) or post-dilution OL-HDF (post-HDF), is conducted to efficiently remove low molecular weight proteins from the blood of patients requiring dialysis. β 2 -microglobulin (β 2 -MG) and α 1 -microglobulin (α 1 -MG) are used as biomarkers to evaluate removal efficiency of OL-HDF. We aimed to evaluate the relationship between β 2 -MG and α 1 -MG reduction rates and the amount of albumin leakage. Furthermore, we statistically analyzed the relationship between the α 1 -MG reduction rate and α 1 -MG removal amount, and its suitability as a biomarker for evaluating the removal efficiency of OL-HDF. Methods We collected the results of regularly conducted routine evaluations to assess the efficiency of OL-HDF from cases of patients undergoing maintenance dialysis at our clinic from 2018 to 2019. Data on was collected on both pre-HDF and post-HDF sessions. β 2 -MG and α 1 -MG reduction rates were analyzed. Regression analysis on reduction rates showed a significant correlation between the α 1 -MG reduction rate and the α 1 -MG removal amount. Results We conducted 435 tests on OL-HDF efficiency in 87 cases undergoing maintenance dialysis at our clinic in 2018 and 2019. There were 80.7 ± 4.5% for the β 2 -MG reduction rate, 33.8 ± 9.4% for the α 1 -MG reduction rate, and 3.9 ± 1.8 g/s for the amount of albumin leakage. There was no correlation between the β 2 -MG reduction rate and the α 1 -MG reduction rate, or between the amount of albumin leakage and β 2 -MG reduction rate. Conclusion α 1 -MG reduction rate was found to correlate with its removal amount, demonstrating its suitability as a biomarker for evaluating the removal efficiency of OL-HDF. Trial registration Retrospectively registered.

Suitability of α1-microglobulin reduction rate as a biomarker of removal efficiency of online hemodiafiltration: a retrospective cohort study