ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-PO357

Removal of Large-Middle Molecules on Expanded Hemodialysis (HDx): A Multicentric Observational Study of 6 Months Follow-Up

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Cantaluppi, Vincenzo, University of Piemonte Orientale (UPO), Novara, Italy
  • Donati, Gabriele, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
  • Lacquaniti, Antonio, Papardo Hospital, Messina, Italy
  • Cosa, Francesco, Ospedale Civile Di Legnano, Taranto, Italy
  • Gernone, Giuseppe, ASL BA - "S. Maria degli Angeli" Hospital - Putignano (Bari) - Italy, Putignano, Italy
  • Marengo, Marita, S.C. Nefrologia e Dialisi, ASLCN1, Savigliano, Italy
  • Teatini, Ugo, ASST Rhodense, Milano, Italy

HemoDialysis expanded (HDx) may potentially represent an innovative way to remove uremic toxins of Large-Medium Molecular weight (LMMs, ≤45 Kda) thanks to the membrane medium cut-off (MCO, Theranova®, Baxter). LMMs are involved in the pathogenic mechanisms of organ dysfunction associated with uremia including inflammation, malnutrition and atherosclerosis. The aim of this study was to evaluate the efficacy of LMMs removal in HDx during an observational multicentric study of 6 months follow-up.


41 HD stable patients (age 67,6±13,4) were dialyzed in HDx with Theranova® 400 (1.7 m2). Each patient was evaluated at baseline with standard HD (T0), 3 months (T3) and 6 months (T6) after HDx. In the first session of the week (for each period), we evaluated the following pre-dialysis parameters: Urea, Creatinine (Creat), Phosphate (P), Beta2-microglobulin (B2m), Myoglobin (Myo), Free Light Chains (FLC-k, FLC-λ), Hemoglobin (Hb), Albumin and C Reactive Protein (CRP). Data are reported as mean ± standard deviation (SD).


HDx therapy was well tolerated without evidence of major adverse side effects. The main results of the study are summarized in Figure 1. After 3 months of HDx (T3), we observed a significant decrease of pre-dialysis levels of urea (p=0,008), B2m (p=0,003), FLC-k (p=0,026), FLC-λ (p=0,001). No significant differences of the other uremic toxins between the periods (T3 vs. T6) were observed. Albumin levels remained stable during all the study period. A significant decrease of CRP was observed at T3 and T6, suggesting a positive effect of HDx on inflammatory parameters correlated with a worse outcome.


HDx therapy provided high removal of different LMMs, leading to a significant reduction of molecules involved in uremia-associated organ dysfunction in the first 3 months of treatment (T0-T3). Long-term studies with a larger sample size are needed to evaluate the clinical impact of HDx. However, our preliminary data suggest that HDx may improve LMMs removal and inflammatory parameters.

Figure 1: Pre-dialysis levels of different uremic toxins at study start (T0) and after 3 (T3) and 6 (T6) months of HDx.