Effects of Expanded Hemodialysis Therapy on Clinical Outcomes

Abstract

The invention of dialysis has been a phenomenal advance in the treatment of kidney failure. The introduction of artificial kidneys in clinical care remains one of the most successful lifesaving interventions in modern medicine. Its glory, however, has been tempered by poor long-term outcomes and a negative qualitative impact on the lives of patients who suffer from an extremely complex, burdensome, and restricted life on dialysis. There remains a huge gap in patient well-being and outcomes between artificial kidney treatments and kidney transplantation. The inadequacy of dialysis, at least in part, is due to the chronic accumulation of organic retention solutes of middle and large molecules in chronic kidney disease, which are poorly removed by current dialytic treatment modalities. Incremental benefits observed through alternative strategies such as high volume hemodiafiltration, high frequency, and expanded hemodialysis (HD) schedules have had limited success, due to a host of organizational, complex technology need and human factor barriers. Expanded HD (HDx) therapy offers a novel blood purification technology, with the use of high retention onset (HRO) membranes designed to achieve a superior spectrum of solute waste removal in uremia. Limited studies have demonstrated the potential benefit of HRO membranes in reducing cardiovascular risk, vascular calcification, and inflammation commonly associated with the "residual uremic syndrome" and patient symptom burden. Robust and efficient clinical trials are now required to establish the rationale and impact of HDx therapy in driving improvements in both physician-and patient-directed clinical goals and outcomes in dialysis.

Is Expanded Hemodialysis an Option to Online Hemodiafiltration for Small- and Middle-Sized Molecules Clearance?

“…This study shows that HDx reduces the vascular calcifications in chronic HD patients. There is growing evidence in favor of the HDx benefits on clinical outcomes [24].…”

Chronic inflammation in end-stage renal disease and dialysis

“…However, since no replacement solution or elevated ultrafiltration rates are needed to perform the therapy, this implies a practical benefit over the currently used HDF techniques, where high volumes of replacement fluid are needed to achieve significantly different outcomes. Indeed, the first reports show comparable or even superior results of HDx compared with HDF, with a simpler treatment and less technical requirements [ 51 , 52 ]. In two prospective, open-label, controlled, randomized, crossover pilot studies, 39 prevalent HD patients were studied in four dialysis treatments with medium cut-off (MCO) prototype dialysers and high-flux dialysers.…”

An initial evaluation of expanded hemodialysis on hospitalizations, drug utilization, costs, and patient utility in Colombia

“…Dialysis remains an essential treatment for patients with conditions such as chronic kidney disease (CKD) and kidney failure (KF) in which kidneys stop functioning. Dialysis has been proven to extend life in patients with KF, but it is also limited in terms of long‐term outcomes and quality of life [ 1 ]. A known problem with low flux hemodialysis is that while it filters small urine‐related toxic molecules, it is not able to filter potentially toxic medium‐size molecules [ 2 ].…”

“…A known problem with low flux hemodialysis is that while it filters small urine‐related toxic molecules, it is not able to filter potentially toxic medium‐size molecules [ 2 ]. High flux hemodialysis (HD HF) was an improvement but remains limited in medium‐size molecule filtration [ 1 , 3 ]. A relatively recent improvement known as hemodialfiltration (HDF) can improve medium‐size molecule filtration, but it generally requires a complex infrastructure for ultrapure water, HDF‐specific hemodialysis monitors, as well as personnel with appropriate clinical experience and training which may be associated with higher costs [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”