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Impact of High-Efficiency Dialysis Modalities on Interdialytic Blood Pressure Profiles: A Randomized Cross-Over Study
Jan Michał Biedunkiewicz1, Agnieszka Zakrzewska2, Katarzyna Jasiulewicz2
1Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland.
Medicina (Kaunas, Lithuania)
|December 31, 2025
Summary
Expanded hemodialysis (HDx) modestly reduced interdialytic blood pressure (BP) compared to high-efficiency hemodialysis (HDF) and standard hemodialysis (HD). HDx demonstrated superior BP control in end-stage kidney disease patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Dialysis Technology
Background:
- Interdialytic blood pressure (BP) is a crucial indicator of volume status and cardiovascular risk in hemodialysis (HD) patients.
- High-efficiency dialysis techniques, including online hemodiafiltration (HDF) and expanded hemodialysis (HDx), aim to enhance solute clearance and hemodynamic stability.
- The comparative efficacy of these advanced HD modalities on interdialytic BP control remains incompletely understood.
Purpose of the Study:
- To compare the interdialytic blood pressure profiles of expanded hemodialysis (HDx) against high-flux hemodialysis (HD) and various online hemodiafiltration (HDF) configurations.
- To evaluate the impact of different high-efficiency dialysis techniques on systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP) between dialysis sessions.
Main Methods:
- A randomized cross-over study involving sixteen stable end-stage kidney disease patients undergoing sequential treatment with high-flux HD, HDx, and HDF (pre-, post-, mixed-dilution).
- Each modality was applied for one month with standardized dialysis prescriptions, dry weight, and antihypertensive regimens.
- Home BP was monitored twice daily on non-dialysis days, with approximately 3600 observations analyzed using repeated-measures ANOVA.
Main Results:
- Significant differences in interdialytic SBP (p=0.009), DBP (p=0.004), and MAP (p<0.001) were observed across the dialysis modalities.
- Expanded hemodialysis (HDx) achieved the lowest mean BP: SBP 129 mmHg, DBP 74 mmHg, MAP 93 mmHg.
- HDx demonstrated significantly lower BP compared to high-flux HD and post-dilution HDF (p<0.05), with non-significant differences versus pre- and mixed-HDF.
Conclusions:
- Expanded hemodialysis (HDx) offers a modest yet consistent reduction in interdialytic blood pressure compared to other high-efficiency dialysis techniques.
- HDx may represent a valuable option for improving hemodynamic management and cardiovascular risk in hemodialysis patients.
- Further research is warranted to elucidate the long-term clinical benefits of HDx on BP control and cardiovascular outcomes.
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