Work

Impact of Expanded Hemodialysis on Inflammation and Iron Metabolism in Chronic Hemodialysis Patients

Year: 2026

Type: article

Abstract: Microinflammation and functional iron deficiency are major contributors to anemia and treatment burden in maintenance hemodialysis (HD). Medium cutoff (MCO) membranes enhance the removal of middle- and large-sized solutes implicated in these pathways, yet real-world data using routinely measured inflammatory and iron-related markers are scarce. This study examined the effects of MCO-based expanded HD on inflammatory indices, iron metabolism, and anemia-related treatment requirements. In this single-center retrospective study, 22 maintenance HD patients (11 who continued on high-flux dialyzers and 11 who were switched to MCO dialyzers) were followed for 24 weeks. Baseline and 24-week assessments included C-reactive protein (CRP), the CRP/albumin ratio, neutrophil count, and composite inflammatory indices, as well as serum iron, transferrin saturation (TSAT), total iron-binding capacity (TIBC), and ferritin. Monthly intravenous iron supplementation and weekly erythropoiesis-stimulating agent (ESA) doses were also documented. Baseline characteristics were comparable between groups. Over the 24-week period, the MCO group showed a significant decline in neutrophil count (p = 0.042) and downward trends in CRP and the CRP/albumin ratio, while both markers increased significantly in patients maintained on high-flux dialyzers. Serum albumin remained stable in all participants. Parallel to the improvement in inflammation, the MCO group demonstrated significant enhancements in iron-handling parameters, with higher serum iron (p = 0.008) and TSAT (p = 0.005), and lower TIBC (p = 0.007), none of which were observed in the high-flux group. Between-group Δ-differences were significant for CRP (p = 0.010), CRP/albumin ratio (p = 0.013), serum iron (p = 0.040), TIBC (p = 0.005), and TSAT (p = 0.005). Hemoglobin levels remained stable in both groups, while intravenous iron and ESA requirements showed modest within-group reductions in the MCO cohort. In this exploratory retrospective analysis, MCO membrane use was associated with favorable trends in inflammatory markers and iron-handling parameters, alongside modest within-group reductions in intravenous iron and ESA requirements, without compromising serum albumin. These findings suggest that MCO therapy may help mitigate microinflammation and support more efficient anemia management in real-world HD practice.

Source: Seminars in Dialysis

DOI: 10.1111/sdi.70033

Authors: Berrak Itır Aylı, Gülay Ulusal Okyay, Mehmet Deniz Aylı

Institutions: University of Westminster, Sağlık Bilimleri Üniversitesi, Ankara Etlik City Hospital

Language: English

Topic: Dialysis and Renal Disease Management

Subfield: Nephrology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,730