Overview of new renal replacement therapy: Expanded hemodialysis
Main Article Content
Abstract
In recent years, expanded hemodialysis (HDx) has attracted much attention due to its use of medium cut-off membranes (MCO) with a unique structure that enhances the removal of larger middle molecules compared to conventional hemodialysis, without requiring complex equipment or techniques. Many countries around the world have routinely applied this method and have demonstrated its effectiveness in improving the prognosis of patients with end-stage renal disease. In Vietnam, several medical facilities have begun to adopt this therapeutic method. Therefore, we conducted this narrative review to provide updated information and a comprehensive evaluation of HDx therapy, including its theoretical basis and current research. This aims to enhance the quality of treatment for patients with end-stage renal disease.
Article Details
Keywords
Expanded hemodialysis, medium cut-off membranes, uremic toxins
References
2. Yu X. The Evolving Patterns of Uremia: Unmet Clinical Needs in Dialysis. Contributions to nephrology. 2017;191:1-7. doi:10.1159/000479251
3. Zhang Z, Yang T, Li Y, et al. Effects of expanded hemodialysis with medium cut-off membranes on maintenance hemodialysis patients: a review. Membranes. 2022;12(3):253. doi:10.3390/membranes12030253
4. Ronco C. The rise of expanded hemodialysis. Blood purification. 2017;44(2):I-VIII. doi:doi.org/10.1159/0004760 12
5. Fiorentino M, La Fergola F, De Rosa S. Medium cut-off dialyzer for middle molecular uremic toxins in AKI and chronic dialysis. Journal of Nephrology. 2024/01/01 2024;37(1):23-37. doi:10.1007/s40620-023-01771-0
6. García-Prieto A, de la Flor JC, Coll E, et al. Expanded hemodialysis: what’s up, Doc? Clinical Kidney Journal. 2023;16(7):1071-1080. doi:10.1093/ckj/sfad033
7. Reis T, Anwar S, Neves FdAdR, et al. Disruptive technologies for hemodialysis: medium and high cutoff membranes. Is the future now? Jornal brasileiro de nefrologia. 2021;43(3):410-416. doi:10.1590/21758239-JBN-2020-0273
8. Lindgren A, Fjellstedt E, Christensson A. Comparison of Hemodialysis Using a Medium Cutoff Dialyzer versus Hemodiafiltration: A Controlled Cross-Over Study. International journal of nephrology and renovascular disease. 2020;13:273-280. doi:10.2147/ijnrd.S263110
9. Ronco C, La Manna G. Expanded hemodialysis: a new therapy for a new class of membranes. Contributions to nephrology. 2017;190:124-133. doi:10.1159/000468959.
10. Heyne N. Expanded hemodialysis therapy: prescription and delivery. Contributions to nephrology. 2017;191:153-157. doi:10.1159/000479263
11. Toro-Cisneros ND, Zuñiga-González EY, Caballero-Islas AE, et al. Are Medium Cut-off Membranes the Future, or the Promising Reality for Chronic Hemodialysis Patients? Revista de investigación clínica; organo del Hospital de Enfermedades de la Nutrición. 2023;75(6):289-299. doi:10.24875/RIC.23000213
12. Kandi M, Brignardello-Petersen R, Couban R, et al. Effects of Medium Cut-Off Versus High-Flux Hemodialysis Membranes on Biomarkers: A Systematic Review and Meta-Analysis. Canadian journal of kidney health and disease. 2022;9:20543581211067090. doi:10.1177/20543581211067090
13. Penny JD, Jarosz P, Salerno FR, et al. Impact of expanded hemodialysis using medium cut-off dialyzer on quality of life: application of dynamic patient-reported outcome measurement tool. Kidney medicine. 2021;3(6):992-1002. e1. doi:10.1016/j.xkme. 2021.05.010.
14. Kandi M, Brignardello-Petersen R, Couban R, et al. Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis. Canadian journal of kidney health and disease. 2022;9:20543581211067087. doi:10.1177/20543581211067087
15. Zhao Y, Gan L, Niu Q, et al. Efficacy and safety of expanded hemodialysis in hemodialysis patients: a meta-analysis and systematic review. Renal failure. Dec 2022;44(1):541-550. doi:10.1080/0886022x.2022. 2048855
16. Maduell F, Broseta JJ, Gómez M, et al. Determining factors for hemodiafiltration to equal or exceed the performance of expanded hemodialysis. Artificial Organs. 2020;44(10):E448-E458. doi:10.1111/aor.13700
17. Serrano Salazar ML, Portolés J, de Valdenebro Recio M, et al. Effect of Expanded Hemodialysis with Theranova® in Patients with COVID-19. Blood purification. 2022;51(10):857-865. doi:10.1159/000520891
18. Hung YH, Lai TS, Belmouaz M, et al. Effects of Medium Cut-Off Polyarylethersulfone and Polyvinylpyrrolidone Blend Membrane Dialyzers in Hemodialysis Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Membranes. Apr 20 2022;12(5)doi:10.3390/membranes12050443
19. Yang J, Ke G, Liao Y, et al. Efficacy of medium cut-off dialyzers and comparison with high-flux dialyzers in patients on maintenance hemodialysis: A systematic review and meta-analysis. Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. Aug 2022;26(4):756-768. doi:10.1111/1744-9987.13755
20. Lukkanalikitkul E, Kidkaem H, Phonrat M, et al. A randomized trial comparing medium cut-off membrane dialyzers with online hemodiafiltration for uremic toxins clearance in hemodialysis patients. Scientific Reports. 2025/02/14 2025;15(1):5467. doi:10.1038/s41598-025-89197-5
21. Lee Y, Jang MJ, Jeon J, et al. Cardiovascular Risk Comparison between Expanded Hemodialysis Using Theranova and Online Hemodiafiltration (CARTOON): A Multicenter Randomized Controlled Trial. Scientific Report. May 24 2021;11(1):10807. doi:10.1038/s41598-021-90311-6