Expanded Hemodialysis and Its Impact on Reducing Hospitalization Rates and Medication Usage
The number of patients with end-stage kidney disease is increasing. New approaches and technological advancements in recent decades have contributed to improving hemodialysis treatment. Does the use of so-called expanded hemodialysis lead to better outcomes?
Introduction
Long-term outcomes for chronically hemodialyzed patients have greatly improved in recent years—there has been a reduction in mortality, morbidity, and an increase in the 5-year survival rate. Despite this, patients with end-stage renal disease (ESRD) remain a significant burden on healthcare systems worldwide. Complications arising from the retention of large uremic toxins (> 25 kDa), now referred to as large middle molecules, contribute to this burden. Removing these substances from the body is challenging, and technological advances aim to ameliorate this situation.
Expanded hemodialysis (HDx) can remove large middle molecules from the circulation while retaining albumin. Its use could potentially reduce the number of adverse events and the consequent need for additional medical care.
The goal of the cited study was to identify the potential benefits of HDx in a cohort of chronically hemodialyzed patients who transitioned from high-flux hemodialysis (HF-HD) to HDx.
Methodology and Study Course
This multicenter observational cohort study included adult patients with documented ESRD on chronic hemodialysis. Three nephrology centers participated in the study.
Patients had to be on HF-HD for at least 1 year and then transitioned to HDx, which also lasted for at least 1 year. Over these 2 years, their laboratory parameters, hospitalizations, medications, and adverse events were monitored and subsequently analyzed.
Results
Eighty-one patients with an average age of 61.1 years were included in the study.
The number of hospitalizations per patient per year decreased from 0.77 (n = 61; 95% CI 0.60–0.98) to 0.71 (n = 57; 95% CI 0.55–0.92; p = 0.6987) within 12 months after transitioning to HDx. The number of hospitalization days per patient per year significantly decreased from 5.94 days to 4.41 days after transitioning to HDx (p = 0.0001).
Doses of erythropoiesis-stimulating agents (p = 0.0361) and intravenously administered iron (p = 0.0003) also significantly decreased after transitioning to HDx. A reduction in adverse events related to hemodialysis was also observed after transitioning to HDx; notably, no adverse events related to the dialysis membrane were reported.
Conclusion
In this cohort study of chronically hemodialyzed patients, transitioning to expanded hemodialysis was associated with fewer hospitalization days per patient per year and a reduced need for erythropoiesis-stimulating agents and intravenous iron.
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Sources:
1. Sanabria R. M., Hutchison C. A., Vesga J. I. et al. Expanded hemodialysis and its effects on hospitalizations and medication usage: a cohort study. Nephron 2021; 145: 179–187, doi: 10.1159/000513328.
2. Wolley M. J., Hutchison C. A. Large uremic toxins: an unsolved problem in end-stage kidney disease. Nephrol Dial Transplant 2018; 33 (suppl. 3): iii6–iii11.
3. HDx therapy with the THERANOVA dialyzer for renal care. Baxter, 2021. Available at: www.baxter.cz/cs/odbornici-ve-zdravotnictvi/renalni-pece/hdx-terapie-s-dialyzatorem-theranova-pro-renalni-peci
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