Open AccessThe Next Evolution of HemoDialysis eXpanded: From a Delphi Questionnaire-Based Approach to the Real Life of Italian Dialysis Units
Author(s) -
Sergio Dellepiane,
Marita Marengo,
Mario D’Arezzo,
Gabriele Donati,
Paolo Fabbrini,
Antonio Lacquaniti,
Claudio Ronco,
Vincenzo Cantaluppi
Publication year - 2022
Publication title -
blood purification
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 57
eISSN - 1421-9735
pISSN - 0253-5068
DOI - 10.1159/000522038
Subject(s) - hemodialysis , medicine , dialysis , nephrology , delphi method , clinical trial , clearance , clinical practice , quality of life (healthcare) , dialysis adequacy , intensive care medicine , urology , physical therapy , computer science , nursing , artificial intelligence
Impact assessment of new technologies in chronic hemodialysis (HD) is challenging due to HD patient frailty, the complexity of HD clinical trials and practice variability among countries. Among the most recent HD innovations, medium cut-off (MCO) dialyzers present an optimized membrane geometry that provides enhanced clearances for middle and large molecular weight uremic toxins (UT). These toxins are poorly cleared by available HD techniques and largely contribute to patient morbidity and mortality. The aim of this paper is to assess the available clinical evidence about MCO membranes and to identify the next steps needed to generate conclusive data on their use in HD. Methods: With this purpose, we first reviewed and compared the current HD technologies aimed to improve the clearance of middle and large UT; subsequently, we used a Delphi questionnaire to identify and discuss the consensus about MCO efficacy within a large sample of the Italian Nephrology community. Results and Conclusions: Our investigation gathered a significant degree of consensus on the beneficial role of MCO membrane and expanded HD. Finally, we used our results to propose future trial designs and clinical investigations aimed to improve evidence quality about the use of these membranes in the present clinical scenario of dialysis units.