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The Next Horizon in Dialysis is Closer Than You Think

HDx, dialysis, hemodialysis, expanded HD, expanded hemodialysis

The Next Horizon in Dialysis is Closer Than You Think

The new HDx therapy (expanded HD) is the next evolution in hemodialysis, as it effectively targets the removal of large middle molecules.2 Indeed, many of them are linked to the development of inflammation, cardiovascular disease, and other co-morbidities in dialysis patients.3  Not only can HDx therapy provide HDF performance and beyond in the removal of conventional middle and large middle molecules, it does so using regular HD workflow and infrastructure.4

This therapy opens up an option for dialysis patients who are believed to benefit from effective removal of large uremic toxins, for clinics that want expanded dialysis performance without the added burden of HDF.

HDx Therapy Facts & Figures


HDx treatments have already been delivered1


Clinics are offering HDx as a therapy option to their patients1


Countries have launched HDx, with many more to come1

HDx, dialysis, hemodialysis, expanded HD, expanded hemodialysis

Change One Thing, Change Everything

Mortality from cardiovascular and infectious events in HD remains unsatisfactorily high with current dialytic therapies.5 Large middle molecules have been associated with inflammation, cardiovascular events and other dialysis-related comorbidities.6 Current dialytic therapies, though efficient in removing small solutes, have limited capability in removing large middle molecules.7

HDx is a new therapy targeting an efficient removal of large middle molecules, without the need for a more complex setup than in regular HD. The HDx therapy is delivered with an innovative dialyzer featuring a new type of membrane, combining a higher permeability than high-flux dialyzers with effective selectivity to retain essential proteins. 8,9

HDx, Theranova, dialysis, hemodialysis

The Importance of Dialytic Removal of Large Middle Molecules

Today, large middle molecules - larger in size than beta 2 microglobulin - are an increasingly important consideration in the prescription of dialysis treatment.10 Dialytic removal of such large middle molecules is desired and, therefore, strategies for the effectiveness of this process need be developed.7 Progressive loss of renal function leads to accumulation of several uremic toxins that range in size from 15 to 55 kDa. These are larger middle molecules, and they are not effectively removed by current dialytic modalities, unless the dialyzer membrane pore size is large enough.7

Free immunoglobulin light chains (kappa and lambda FLCs, 22.5 and 45 kDa, respectively): plasma levels of kappa and lambda FLCs progressively increase as renal function deteriorates.

Complement factor D (24 kDa): circulating rate-limiting enzyme in the alternative complement system11 that in advanced kidney disease shows approximately a 10-fold increase in plasma.12

Alpha 1 microglobulin (33 kDa): commonly used marker for the removal of large middle molecules by dialysis.13

YKL-40 (40 kDa): plasma level is approximately doubled in dialysis patients compared to healthy people and shows a positive correlation with the C-reactive protein level in plasma.14

hemodialysis, HDx,

Turning Innovative Design into a Clinical Solution

The innovative dialyzer enables the HDx therapy by combining 4 therapeutic principles: permeability, selectivity, retention and internal filtration – into a single dialyzer design. Its innovative medium cut-off (MCO) membrane expands the range of solutes removed during regular dialysis, while retaining essential proteins at a safe and controlled level. This unique cut-off and retention onset profile allows for filtration close to that of the natural kidney. 8,9

Learn more about the innovative dialyzer

Important Safety Information

For safe and proper use of products mentioned herein, please refer to the appropriate Operators Manual or Instructions for Use.