Kidney Week

Abstract: FR-PO0501

Medium Cutoff Dialyzers vs. Hemodiafiltration in Maintenance Hemodialysis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Session Information

• Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Arslan, Felemez, Istanbul Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey

Felemez Arslan, MD

• de Almeida, Vitor Paiva, Federal University of Catalão, Catalão, Brazil

Vitor Paiva de Almeida

• Silva, Rafaela Pereira, Federal University of Maranhão, São Luís, Brazil

Rafaela Pereira Silva

• Magal, Abhijith, Kuavery Hospital, Bangalore, Karnataka, India

Abhijith Magal, MD, MBBS

• Bayer, Ekin Siar, Istanbul Saglik ve Teknoloji Universitesi, Istanbul, Turkey

Ekin Siar Bayer

Background

Medium cut-off (MCO) dialyzers offer expanded hemodialysis by targeting middle and large middle molecules, presenting a simpler alternative to hemodiafiltration (HDF) or online HDF. However, their comparative effectiveness and safety remain uncertain.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing MCO dialyzers with HDF or online HDF in adults receiving maintenance hemodialysis. PubMed, Embase, and Cochrane databases were searched through April 2025. Random-effects models were used to pool mean differences (MD) in solute reduction ratios with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics.

Results

Six RCTs involving 148 patients were included. MCO dialyzers demonstrated a significantly higher reduction ratio for YKL-40 (MD: 15.51; 95% CI: 7.38 to 23.64; p = 0.0002) and for lambda-FLC in crossover trials (MD: 12.43; 95% CI: 11.27 to 13.59; p < 0.00001). HDF achieved a significantly higher reduction for β2-microglobulin (MD: –2.86; 95% CI: –5.65 to –0.06; p = 0.05). No significant differences were observed for urea or phosphate. Albumin loss per session did not differ significantly (MD: 2.01 g/session; 95% CI: –0.37 to 4.39; p = 0.10).

Conclusion

Expanded dialysis with MCO provides superior clearance of large middle molecules compared to HDF, without significantly greater albumin loss. HDF remains more effective for small middle molecules, while both modalities demonstrate comparable efficacy in small solute clearance. These findings suggest that dialysis modality selection could be guided by specific solute clearance goals and individual patient characteristics.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025rhdqrttk