Real-world effectiveness of central dialysis fluid delivery system (CDDS) in maintenance hemodialysis: a...

This study aimed to compare the real-world effectiveness of a central dialysis fluid delivery system (CDDS) with single-patient dialysis delivery systems (SPDDS) in patients undergoing maintenance hemodialysis (MHD), focusing on inflammation markers, nutritional status, and dialysis adequacy. We conducted a retrospective cohort analysis of 368 MHD patients from three hemodialysis centers in Shanghai, China, between January 2020 and June 2023 was analyzed (CDDS, n = 253; SPDDS, n = 115). Generalized linear mixed-effects models were used to evaluate longitudinal associations between dialysate delivery systems and clinical outcomes. Subgroup analyses were performed to examine effect modification by age, diabetes status, baseline inflammation, and dialysis modality. Compared with SPDDS, CDDS was associated with higher levels of total protein (β = 0.91 g/L), albumin (β = 1.71 g/L), and hemoglobin (β = 3.50 g/L) after multivariable adjustment (all p < 0.05), while no statistically significant differences were observed in creatinine or urea reduction after adjustment. Subgroup analysis indicated that CDDS was particularly effective in improving albumin levels among patients aged < 70 years, those with diabetes, or those with elevated CRP levels. In patients aged ≥ 70, CDDS was associated with better anemia control and enhanced dialysis adequacy. Nutritional benefits were consistently observed in patients receiving a regimen of twice-weekly high-flux hemodialysis combined with once-weekly hemodiafiltration. In conclusion, CDDS use was associated with improved nutritional and hematologic indicators in this real-world cohort, while differences in inflammatory markers and dialysis adequacy were not statistically significant after multivariable adjustment.