Super-high-flux hemodialysis versus high-flux hemodialysis in an Ecuadorian dialysis population.

Abstract

Introduction: Survival and quality of life (QoL) in hemodialysis (HD) patients are affected by the retention of middle-molecular-weight toxins (MMWTs). Super-high-flux hemodialysis (HDs), utilizing medium cut-off (MCO) membranes, optimizes the clearance of these toxins compared to high-flux hemodialysis (HD-AF). The objective was to compare clinical, anthropometric, QoL, and clearance parameters between the two modalities.

Materials and Methods: A randomized, controlled, crossover experimental study was conducted in Ecuador involving 159 patients. Subjects were assigned to two groups, alternating between HDs and HD-AF over six-month periods. Elisio HX (HDs) and Elisio H (HD-AF) dialyzers were used alongside ultrapure dialysis fluid. Statistical analysis compared mean differences using independent-samples t-tests (α=0.05).

Results: The study population was predominantly male (65.4%) and aged 40–64 years (54.8%). HDs demonstrated significant improvement in overall QoL compared to HD-AF (2.84 vs. -1.49; p=0.000), with specific benefits regarding general health and disease burden. Significant reductions were observed in parathyroid hormone (PTH) (-52.05 vs. 64.96 pg/mL; p=0.009) and C-reactive protein (CRP) (-2.39 vs. 1.99 mg/L; p=0.020) with HDs. Additionally, fat mass decreased significantly (-1.93 vs. -0.75 kg; p=0.008), and serum iron levels increased (12.09 vs. 3.21 mcg/dL; p=0.023) with the use of HDs.

Conclusions: The transition from HD-AF to HDs results in an increase in perceived quality of life and serum iron levels, as well as a decrease in PTH, CRP, and fat mass levels. These findings suggest that HDs offers superior clinical advantages in the comprehensive management of patients with advanced chronic kidney disease.