Performance-based classification of dialyzers: integrating YKL-40 for advanced middle-molecule clearance - A Chinese...

Recent advancements in membrane technology have significantly improved dialyzer permeability, enabling the enhanced clearance of molecules across a broad spectrum, from small water-soluble solutes to large middle-molecules (LMM). While current end-stage renal disease (ESRD) guidelines recognize three HD modalities (low-flux HD, high-flux HD, and expanded HD), existing dialyzer classification systems fail to adequately incorporate the clearance capacity for larger molecular weight toxins, limiting their clinical utility for optimal dialyzer selection. To address this gap, a working group of Chinese nephrology and blood purification experts convened. Using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology with Delphi surveys, the group developed a performance-based dialyzer classification system. The consensus achieved two key objectives: (1) establishing clinically relevant evaluation indicators for dialyzer performance, and (2) proposing an improved classification framework based on these parameters. This initiative aligns with the latest international standards for uremic toxin classification and ESRD treatment strategies while specifically focusing on user-centered performance metrics. Building upon existing dialyzer classifications and membrane categories, the consensus provides enhanced differentiation of LMM toxin clearance capabilities. The resulting recommendations aim to guide clinicians in selecting the most appropriate dialyzers for specific patient needs, thereby optimizing the treatment efficacy and patient outcomes. Although developed to address specific challenges in Chinese clinical practice, this consensus offers valuable insights into the global nephrological community. Its practical, performance-oriented approach to dialyzer classification has the potential to improve the standardization of dialysis care worldwide, ultimately benefiting patient safety and treatment quality.