Expanded hemodialysis as effective alternative to on‐line hemodiafiltration: A randomized mid‐term clinical trial

Expanded hemodialysis (HDx), using medium cut‐off membrane, is a novel therapy that effectively clears middle molecules (MMs). We aimed to compare HDx to hemodiafiltration (HDF) in an open randomized clinical study. Patients currently on HDF (age 18–80 years; on HDF >3 months) were randomized to...

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Bibliographic Details
Published in:Therapeutic apheresis and dialysis 2022-02, Vol.26 (1), p.37-44
Main Authors: Hadad‐Arrascue, Fernando, Nilsson, Lars‐Göran, Rivera, Angela S., Bernardo, Angelito A., Cabezuelo Romero, Juan B.
Format: Article
Language:English
Subjects:
erythropoietin resistance index
expanded hemodialysis
Female
Follow-Up Studies
hemodiafiltration
Hemodiafiltration - methods
Humans
Kidney Failure, Chronic - therapy
large middle molecules
Male
medium cut‐off membrane
Middle Aged
Original
Renal Dialysis - methods
Spain
Treatment Outcome
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Summary:Expanded hemodialysis (HDx), using medium cut‐off membrane, is a novel therapy that effectively clears middle molecules (MMs). We aimed to compare HDx to hemodiafiltration (HDF) in an open randomized clinical study. Patients currently on HDF (age 18–80 years; on HDF >3 months) were randomized to switch to HDx (N = 21) or continue HDF (N = 22) with a 24‐week follow‐up. Pre‐ to post‐dialysis reduction ratios (RR) and changes in pre‐dialysis levels over time were evaluated for MMs and clinical biomarkers. Use of erythropoiesis‐stimulating agents (ESAs) was assessed. HDx showed greater RR for YKL‐40 while RR appeared similar between groups for beta2‐microglobulin, FGF‐23, and free light chains. Intradialytic changes in inflammatory biomarkers (IL‐6, CRP, PTX3) did not differ between therapies. Changes from baseline to 12 and 24 weeks did not differ between groups for MMs, inflammatory markers, albumin, fibrinogen, hemoglobin, PTH, and phosphorus. Use of ESAs tended to decrease in HDx arm while remaining stable in HDF arm. HDx appeared safe with similar clinical effectiveness as HDF. With fewer requirements and resource needs, HDx provides an attractive alternative to HDF.
ISSN:1744-9979
1744-9987
DOI:10.1111/1744-9987.13700