Kidney Week

Abstract: TH-PO0859

Beyond Reduction Ratios: Comparison of Convective Therapies Using Equivalent Continuous Dialytic Clearance of β2-Microglobulin

Session Information

• Dialysis: Prescription, Physiology, and Treatment Optimization
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Esteban-Prado, Alejandro, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Alejandro Esteban-Prado, MD

• Zuñiga Gonzalez, Erick Yasar, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Erick Yasar Zuñiga Gonzalez, MD

• Mercado Hernández, Yazmin Alejandra, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Yazmin Alejandra Mercado Hernández, MD

• Quiñonez-Flores, Alejandro, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Alejandro Quiñonez-Flores, MD

• Ruvalcaba Cristerna, Luisa Svetlana, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Luisa Svetlana Ruvalcaba Cristerna, DrMed

• Carreón Tapia, Daira Magdalena, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Daira Magdalena Carreón Tapia, MEd

• Del Toro-Cisneros, Noemi, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Noemi Del Toro-Cisneros, MD

• Vega, Olynka, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Olynka Vega, MD, MS

Background

High-volume hemodiafiltration (HV-HDF) has demonstrated superiority over high-flux hemodialysis (HD). Expanded hemodialysis (HDx) has emerged as a cost-effective alternative for middle molecule removal. Howerver, no standardized metric exists to compare these modalities. Conventional metrics as Beta-2-microglobulin (β2m) reduction ratio (RR-β2m) and spKt/V-β2m fail to account for distribution volume of the molecule and residual kidney function. We propose the equivalent continuous dialytic clearance of beta-2-microglobulin (ECDC-β2m) for a comprehensive assessment of middle molecule clearance across convective therapies

Methods

In this prospective, observational, single-center study, 583 sessions (332 HV-HDF and 251 HDx) of 240-minute duration were analyzed in anuric patients. ECDC-β2m, RR-β2m and spKt/V-β2m were calculated per session. Convective volume was adjusted (aCV) to total body water (TBW) in the HV-HDF group. A linear mixed-effects model assessed the association between aCV and ECDC-β2m. Analyses and graphics were conducted in R

Results

A total of 40 patients were included (25 HV-HDF, 15 HDx). Baseline characteristics were comparable between groups. HV-HDF achieved greater β2m removal than HDx across all metrics (Table 1). Median ECDC-β2m was higher in HV-HDF vs. HDx (13.1 [IQR 11.3–15.6] vs. 10.2 [9.03–11.5] mL/min, p < 0.001). A positive association between aCV and ECDC-β2m (β = 4.25, R²m = 0.095, p < 0.001) confirmed a dose-response relationship

Conclusion

ECDC-β2m is a robust metric for evaluating middle molecule clearance across convective therapies. HV-HDF demonstrated superior β2m clearance vs. HDx. ECDC-β2m provides a standardized and physiological based framework for comparing extracorporeal therapies and optimizing middle molecule removal in dialysis patients