Expanded hemodialysis: what’s up, Doc?

Abstract

In the last years there has been an increasing interest in expanded hemodialysis (HDx), an emerging renal replacement therapy based on the use of medium cut off membranes (MCO). Thanks to the internal architecture of these type of membranes with a higher pore size and smaller fiber inner diameter to favour internal filtration rate they can increase the removal of larger middle molecules in conventional hemodialysis. Secondarily, several reports suggest that this therapy potentially improve the outcomes for end-stage renal disease patients. However, HDx has not been defined yet and the characteristics of MCO membranes are not well stablished. The aim of this narrative review is to define HDx and summarize the dialyzers that have been used so far to perform this therapy, collect the evidence available on its efficacy and clinical outcomes compared to other hemodialysis technics and settle the bases for its optimal prescription.

Expanded Hemodialysis ameliorates uremia-induced impairment of vasculoprotective KLF2 and concomitant proinflammatory priming of endothelial cells through an ERK/AP1/cFOS-dependent mechanism

“…High cardiovascular morbidity and mortality, caused in part by chronic inflammation associated with endothelial dysfunction, remains a major challenge in the management of CKD and ESRD patients with underlying uremia and systemic microinflammation ( 8 – 12 ). Endothelial cells (ECs) - as a direct barrier to the uremic substances in the blood - are essential for maintaining vascular homeostasis ( 49 ).…”

“…This is in line with our prior results on the response of ECs to uremic microinflammation in the context of endothelial maladaptation ( 7 ). Linking the modulation of KLF2, a key vascular transcription factor, to this study provides further insight into the mechanisms underlying the beneficial effect of expanded hemodialysis with improved medium cut-off (MCO) dialyzers ( 8 – 12 ).…”

“…Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are a major public health burden despite recently improved global awareness and better access to kidney care ( 1 – 4 ). In addition to kidney transplantation (KTx) ( 5 ), several renal replacement therapies (RRTs), such as peritoneal dialysis (PD) ( 6 ) and hemodialysis (HD) ( 7 ), offer well-established life-sustaining therapies for ESRD patients ( 4 ), which are nonetheless still associated with a considerable need for improvements considering their long-term morbidity and mortality outcomes ( 8 – 12 ).…”

“…These complications can project into the manifestation of chronic microvascular injury, which in turn promotes the cardiovascular and post-inflammatory risks and detrimentally affects patient morbidity and mortality in the long run ( 14 , 15 ). Thus, in order to optimize existing RRT treatments, intense research is currently ongoing to stepwise overcome any evident RRT-related chronic complications ( 8 – 12 ).…”

Alleviation of Oxidative Stress during Hemodialysis Sessions by Hemodialysis Membrane Innovation: A Multidisciplinary Perspective

“…Vitamin E-coated membranes have also recently been used for expanded hemodialysis [39]. In a small prospective study, Maduell et al [40] found that the removal of medium-sized solutes, such as myoglobin, kappa-free immunoglobulin light chains, prolactin, and α1-microglobulin, in expanded hemodialysis with the vitamin E-coated membrane (Vie-18X, Asahi) was significantly higher than that in high-flux hemodialysis.…”