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Redefining Hemodialysis: Beyond Diffusion to Precision Therapy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 15 August 2026 | Viewed by 1210

Special Issue Editors


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Guest Editor
Global Medical Office, Fresenius Medical Care, 26020 Palazzo Pignano, Italy
Interests: hemodialysis; dialysis; balanced scorecard; strategy; nephrology; management; hypertension; diabetes; doppler; supply chain management; internal medicine; blood pressure; renal disease

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Guest Editor
Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA 02114, USA
Interests: acute kidney injury; AI, atrial natriuretic factor; calciphylaxis; cardiovascular surgical procedures; diuretics; hospitalists; hyponatremia; kidney failure, chronic; natriuretic peptides; referral and consultation; renal dialysis; renal insufficiency, chronic; thiosulfates; uremia; vascular calcification

Special Issue Information

Dear Colleagues,

Despite major technological progress, hemodialysis continues to be associated with high mortality, frequent hospitalization, and a persistent burden of cardiovascular, inflammatory, metabolic, and cognitive complications. Diffusion-centered therapies are no longer sufficient to address the complexity of advanced kidney failure, characterized by middle- and larger-molecular-weight toxin accumulation, chronic inflammation, fluid overload, oxidative stress, endothelial dysfunction, and hemodynamic instability.

This Special Issue, “Redefining Hemodialysis: Beyond Diffusion to Precision Therapy”, will highlight innovative, physiology-driven strategies to transform dialysis into a more effective, personalized, and outcome-orientated therapy. Areas of interest include optimized convective clearance, advances in membrane and adsorption technologies, individualized fluid management, the targeted modulation of inflammation and oxidative stress, and improved gas-exchange strategies to reduce dialysis-induced hypoxia.

We also welcome contributions integrating digitalization, artificial intelligence, digital biomarkers, and machine-learning-based risk prediction to support adaptive prescriptions and continuously tailored treatments. Furthermore, we encourage research advancing environmentally sustainable models—green dialysis—and modern evidence-generation frameworks such as novel clinical trial designs and clinical trial emulation.

Our aim in launching this Special Issue is a bold and necessary one: to elevate hemodialysis from a life-sustaining intervention to a precision-based, patient-centered, and outcome-driven therapy.

Dr. Stefano Stuard
Dr. Sagar Nigwekar
Guest Editors

Manuscript Submission Information

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Keywords

  • digitalized medical governance
  • precision dialysis
  • convective clearance
  • advanced membranes
  • hemodynamic stability
  • artificial intelligence
  • digital biomarkers
  • personalized prescription
  • cardiovascular protection
  • patient-reported outcome measures
  • clinical trial emulation

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Published Papers (1 paper)

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Review

39 pages, 5408 KB  
Review
Advances in Membrane, Dialyzer Design, and Related Monitoring Technologies for Hemodiafiltration: Translating Bench-Side Innovations to Bedside Applications
by Alfred Gagel, Gerhard Wiesen, Stefano Stuard and Bernard Canaud
J. Clin. Med. 2026, 15(5), 1921; https://doi.org/10.3390/jcm15051921 - 3 Mar 2026
Viewed by 846
Abstract
Background: Online hemodiafiltration (HDF) represents the most advanced form of kidney replacement therapy, combining diffusive and convective transport to enhance the removal of uremic toxins across a wide molecular spectrum. Achieving high convective volumes is a key determinant of treatment efficacy and [...] Read more.
Background: Online hemodiafiltration (HDF) represents the most advanced form of kidney replacement therapy, combining diffusive and convective transport to enhance the removal of uremic toxins across a wide molecular spectrum. Achieving high convective volumes is a key determinant of treatment efficacy and has been associated with improved survival. Beyond small solutes, HDF targets middle molecules and protein-bound uremic toxins (PBUTs), including β2-microglobulin, inflammatory cytokines, and other large uremic compounds implicated in cardiovascular and systemic complications. Aims: This narrative review examines advances in dialysis membrane materials, dialyzer design, and monitoring technologies that optimize mass transfer in HDF. It focuses on the interplay between membrane permeability, hemocompatibility, and convective dose delivery, and discusses how these engineering developments translate into clinical performance. Key mechanisms: Recent progress in synthetic polymer membranes, particularly polysulfone- and polyethersulfone-based systems, and hollow-fiber manufacturing has enabled improved control of pore size distribution, hydraulic permeability, and sieving characteristics. These developments enhance the clearance of middle molecules and selected PBUTs while preserving essential proteins such as albumin. Mechanistic insights into internal filtration, protein polarization, and Donnan effects highlight the complex transport processes occurring within the dialyzer and their interaction with automated HDF systems. Expanded hemodialysis and high-volume HDF approaches further increase the removal of larger solutes but require careful management to limit albumin loss and maintain hemocompatibility. Clinical implications: Optimized membrane design, combined with advanced HDF machine algorithms, allows delivery of high convective volumes under safe and stable conditions, improving removal of β2-microglobulin, cytokines, and other clinically relevant toxins associated with inflammation and cardiovascular risk. However, treatment must remain individualized, considering electrolyte balance, albumin preservation, and patient-specific factors such as inflammation and nutritional status. Mechanistic modeling supports understanding of transport phenomena but must be interpreted cautiously when translated into clinical practice. Conclusions: Advances in membrane science, dialyzer engineering, and monitoring technologies have strengthened the role of HDF as a precision-based renal replacement therapy. Continued innovation aimed at optimizing middle-molecule and PBUT clearance while preserving albumin and treatment stability is essential to improve patient outcomes and support the broader implementation of HDF as a mainstream dialysis modality. Full article
(This article belongs to the Special Issue Redefining Hemodialysis: Beyond Diffusion to Precision Therapy)
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