Next-generation dialysis — middle molecules, evidence gap

Key takeaways:

New kidney replacement modalities promise greater middle-molecule removal vs. conventional hemodialysis.

Research is needed to show a causal link for middle-molecule removal and better clinical out-comes.

Since its development in the mid-20th century, maintenance hemodialysis has revolutionized the treatment of end-stage kidney disease, transforming it from an untreatable diagnosis into a manageable chronic condition.

Despite the life-sustaining benefits or hemodialysis, patients with ESKD continue to face reduced life expectancy, elevated CV risk, persistent inflammation, protein-energy wasting and diminished quality of life. Improving the removal of larger uremic toxins, or “middle molecules,” which conventional dialysis does not clear effectively, is a promising oppor