Abstract: SA-PO1074
Change in Serum Albumin After Initiation of Expanded Hemodialysis
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Weinhandl, Eric D., DaVita Inc, Denver, Colorado, United States
- Giullian, Jeffrey A., DaVita Inc, Denver, Colorado, United States
- Sibbel, Scott, DaVita Inc, Denver, Colorado, United States
- Tentori, Francesca, DaVita Inc, Denver, Colorado, United States
- Brunelli, Steven M., DaVita Inc, Denver, Colorado, United States
Background
Expanded hemodialysis (HD) utilizes a medium cut-off dialyzer with larger pore sizes to increase the clearance of uremic toxins and other solutes of larger molecular weight. The porosity of this dialyzer class results in increased loss of albumin during HD treatment. It has been hypothesized that serum albumin decreases after initiation of expanded HD, but there are no large studies that establish whether this change in serum albumin is clinically significant. In this study, we analyzed serial measurements of serum albumin during the first 6 months of follow-up following dialysis with expanded HD.
Methods
From each of 33 DaVita Kidney Care (DKC) clinics participating in the MODEL initiative, we identified all adult end-stage kidney disease patients who initiated expanded HD on or after first use of a medium cut-off dialyzer (Theranova 400/500, Vantive Healthcare) in the clinic. Contemporaneous control patients who underwent HD with a high-flux (HF) dialyzer were ascertained from 30 randomly selected DKC clinics. Patients were followed for 6 months after initiation of expanded HD (or for control patients, an imputed index date). Patients with ≥1 serum albumin measurement during the 2-month interval ending on the date of follow-up initiation were retained for analysis. Change in serum albumin during follow-up was modeled with a linear mixed model, with adjustment for age, sex, race, HD vintage, and baseline serum albumin.
Results
The cohort included 2,273 patients who initiated expanded HD and 2,434 patients who underwent HD with a HF dialyzer. Mean age was 63.6 years, 58.5% were male, and mean HD vintage was 3.5 years; characteristics were similar between groups. At baseline, mean serum albumin was 3.91 g/dL in the expanded HD group and 3.94 g/dL in the HF dialyzer group. Serum albumin declined 0.1 g/dL during the first 4 months after initiation of expanded HD and then stabilized. Compared to HD with a HF dialyzer, adjusted effects of expanded HD on serum albumin were −0.07, −0.05, and −0.02 g/dL at 4, 5, and 6 months of treatment, respectively.
Conclusion
Relative to HD with a high-flux dialyzer, expanded hemodialysis is associated with a small, clinically insignificant decline in serum albumin, which was mitigated by 6 months of therapy.