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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Kidney Week

Educational Symposium

Removal of Large Middle Molecular Uremic Toxins: Room for Innovation

October 23, 2020 | 01:00 PM - 02:00 PM

Location: Simulive

Session Description

Hemodialysis remains the most common form of kidney replacement therapy worldwide for patients with ESKD. Despite advancements in dialysis technologies, morbidity, and mortality remain high for hemodialysis patients.

Urea clearance is the gold standard for measuring adequate dialysis clearance. The current technology for hemodialysis therapy (high-flux membranes) can clear uremic toxins up to 12,000 Daltons (12 kDa) but has very poor capacity to remove large middle molecular uremic toxins (25-60 kDa). These large middle molecules have been associated with chronic inflammation, atherosclerosis and calcification, structural heart disease, and secondary immunodeficiency.

This symposium discusses a potential role for the removal of these large middle molecules, including consideration of the available technology.

Support is provided by an educational grant from Baxter Healthcare Corporation.

Learning Objective(s)

  • Describe the clinical relevance of large middle molecular uremic toxins in ESKD
  • Discuss the available technologies to remove large middle molecules

Learning Pathway(s)

  • Dialysis


  • Sahir Kalim, MD, FASN


  • Introduction: Current Gaps in Therapies to Remove Large Middle Molecules: The Need for Innovative Approaches
    01:00 PM - 01:10 PM
    Sahir Kalim, MD, FASN 
  • Biology and Clinical Significance of Large Middle Molecular Uremic Toxins in ESKD
    01:10 PM - 01:35 PM
    Peter Stenvinkel, MD, PhD, FASN 
  • Dialysis Modalities and Technologies to Remove Large Middle Molecules
    01:35 PM - 02:00 PM
    Colin A. Hutchison, MBChB, PhD