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Acute and Chronic Hemodialysis: Clinical Updates and Advances
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Acute and Chronic Hemodialysis: Clinical Updates and Advances

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

Deadline for manuscript submissions: 31 December 2026 | Viewed by 2283

Editor

Dr. Gubensek Jakob

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Guest Editor
Department of Nephrology, Center for Acute and Complicated Dialysis and Vascular Access, University Medical Center Ljubljana, Ljubljana, Slovenia
Interests: hemodialysis; vascular access; apheresis; intensive care nephrology; ultrasonography
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hemodialysis is the most common form of renal replacement therapy used for acute renal failure as well as end-stage renal failure worldwide, saving the lives of millions of patients.

Acute dialysis in the intensive-care setting has seen many advances in recent years, including the introduction of hemoadsorption in septic shock, further advances in regional citrate and citrate-free anticoagulation, issues with optimal fluid management, and fine-tuning of indications, especially timing of initiation of dialysis treatment.

In the field of chronic hemodialysis, there is an ongoing competition between hemodiafiltration and expanded hemodialysis with medium cut-off membranes. The issue of the environmental impact of dialysis treatment is gaining increasing attention. There are also advancements in pharmacotherapy in chronic dialysis patients - searching for a proper place for hypoxia-inducible factor (HIF) stabilisers and increasing evidence of the superiority of calcimimetics. The issue of vascular calcifications and their reversibility is an area of intense research. Many issues related to vascular access also present a permanent clinical challenge and possibility for improvement.

This Special Issue aims to attract some of the recent research advancements in the field of acute and chronic dialysis, with a focus on clinical studies and applications of hemodialysis techniques.

Dr. Gubensek Jakob
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hemoadsorption
  • hemodiafiltration
  • medium cut-off membranes
  • expanded hemodialysis
  • vascular calcifications
  • renal anemia
  • vascular access
  • anticoagulation
  • ICU nephrology
  • acute kidney injury

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Published Papers (3 papers)

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Research

12 pages, 287 KB  
Article
Pregnancy Outcomes and Associated Complications in Patients Undergoing Hemodialysis and Their Neonates: A Nationwide Study in South Korea (2014–2022)
by Jee Young Lee, Sang Hyun Park, Hye Won Park, Kyung Won Kim and Tae-Eun Kim
J. Clin. Med. 2026, 15(12), 4621; https://doi.org/10.3390/jcm15124621 - 14 Jun 2026
Viewed by 339
Abstract
Introduction: Pregnancy in women with end-stage kidney disease (ESKD) remains rare and high-risk, despite advancements in dialysis and supportive care. Using a nationwide database in South Korea, this study examined the maternal and neonatal outcomes among women undergoing maintenance hemodialysis, with a [...] Read more.
Introduction: Pregnancy in women with end-stage kidney disease (ESKD) remains rare and high-risk, despite advancements in dialysis and supportive care. Using a nationwide database in South Korea, this study examined the maternal and neonatal outcomes among women undergoing maintenance hemodialysis, with a particular focus on dialysis modality and treatment patterns. Methods: This population-based retrospective cohort study utilized data from the Korean National Health Insurance Service database. The study included all live births between 1 January 2014 and 31 December 2022, linked to mothers who underwent hemodialysis at least twice per week during pregnancy. Results: Between 2014 and 2022, in the Republic of Korea, 31 live births were recorded among 29 women undergoing hemodialysis. The mean maternal age at delivery was 36.1 ± 4.94 years, and most patients had significant comorbidities, including hypertension (79.3%), and diabetes mellitus (48.3%). Cesarean section was the predominant mode of delivery (75.9%). Pregnancy-related complications included preterm delivery (48.4%), preeclampsia (16.1%), and gestational diabetes (16.1%). A total of 16.1% of the neonates had atrial septal defects. During the peripartum period, 93.1% of deliveries occurred at tertiary care centers, and trimester-wise escalation in dialysis frequency was observed. Conclusions: This study provided real-world data on pregnancy-related outcomes among women with ESKD undergoing maintenance dialysis in Korea. Given the rarity of this clinical condition, our findings may serve as a valuable reference for the management of pregnant women with ESKD. Full article
(This article belongs to the Special Issue Acute and Chronic Hemodialysis: Clinical Updates and Advances)
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15 pages, 844 KB  
Article
Targeting Protein-Bound Uremic Toxins: A Dual Approach with Medium Cut-Off Membrane Dialysis and a Dietary Intervention—A Randomized Controlled Study
by Tjaša Herič, Tjaša Vivoda, Špela Bogataj, Aljoša Kuzmanovski, Joško Osredkar, Joanna Giebułtowicz and Jernej Pajek
J. Clin. Med. 2026, 15(9), 3228; https://doi.org/10.3390/jcm15093228 - 23 Apr 2026
Viewed by 766
Abstract
Background/Objectives: Protein-bound uremic toxins (PBUTs), particularly p-cresyl sulfate (PCS) and indoxyl sulfate (IS), are associated with cardiovascular toxicity and increased mortality. Conventional hemodialysis (HD) removes PBUTs poorly, and the efficacy of medium cut-off (MCO) dialyzer membranes remains uncertain. Furthermore, PBUT production is [...] Read more.
Background/Objectives: Protein-bound uremic toxins (PBUTs), particularly p-cresyl sulfate (PCS) and indoxyl sulfate (IS), are associated with cardiovascular toxicity and increased mortality. Conventional hemodialysis (HD) removes PBUTs poorly, and the efficacy of medium cut-off (MCO) dialyzer membranes remains uncertain. Furthermore, PBUT production is influenced by gut microbial metabolism and can be modified through diet. We hypothesized that MCO dialysis would provide superior clearance of PCS and IS compared with online hemodiafiltration (OL-HDF), and that combining MCO dialysis with increased dietary fiber and short-chain fatty acid (SCFA) intake would further reduce PBUT levels. Methods: In this prospective randomized trial, 62 maintenance HD patients underwent a 2-week wash-in period with high-flux HD (HF-HD) and were then randomized to MCO-HD (EXP) or OL-HDF (CON). After a 4-week intervention with the assigned dialysis modality, both groups continued with the same dialysis treatment and received an 8-week dietary intervention consisting of 19 g/day fiber and 1 g/day sodium propionate. The study concluded with a 4-week wash-out period on HF-HD. Primary outcomes were total serum PCS and IS levels measured at four timepoints. Results: Fifty-two patients completed the study. No significant changes in PCS or IS were observed after the dialysis-only intervention. PCS levels remained stable throughout the study. When the aligned dialysis regimen was combined with the dietary intervention, IS levels were significantly lower in the CON than in the EXP group (31.5 ± 10.3 vs. 42.0 ± 15.8 µmol/L; p = 0.006), with a partial rebound after wash-out in the CON group (39.6 ± 20.9 µmol/L; p = 0.003). Conclusions: While MCO-HD and OL-HDF had a similar effect on serum PCS and IS concentrations, only OL-HDF combined with the dietary intervention significantly reduced IS levels. Full article
(This article belongs to the Special Issue Acute and Chronic Hemodialysis: Clinical Updates and Advances)
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12 pages, 494 KB  
Article
Use of High- and Medium-Cut-off Membrane Hemodialysis for Removal of Free Light Chains in Patients with Multiple Myeloma—A Single-Center Experience
by Matevz Skerget, Barbara Vajdic Trampuz, Tajda Starman and Jakob Gubensek
J. Clin. Med. 2026, 15(8), 2917; https://doi.org/10.3390/jcm15082917 - 11 Apr 2026
Viewed by 817
Abstract
Background/Objectives: Light-chain cast nephropathy remains a major cause of morbidity in newly diagnosed multiple myeloma (MM), and rapidly reducing circulating free light chains (FLCs) is considered essential for renal recovery and survival. Methods: We conducted a single-center retrospective study evaluating high- [...] Read more.
Background/Objectives: Light-chain cast nephropathy remains a major cause of morbidity in newly diagnosed multiple myeloma (MM), and rapidly reducing circulating free light chains (FLCs) is considered essential for renal recovery and survival. Methods: We conducted a single-center retrospective study evaluating high- and medium-cut-off hemodialysis (HCO/MCO HD) in newly diagnosed MM patients presenting with acute kidney injury (AKI). Consecutive patients treated at the University Medical Center Ljubljana between 1 January 2020 and 31 December 2023 were included. As per institutional protocols, HCO/MCO HD- and myeloma-directed therapy were initiated on the day of diagnosis. Primary endpoints were the magnitude of FLC reduction, renal and hematologic responses at three months, and overall survival. Results: The median FLC concentration at presentation was 9630 mg/L. FLC levels declined rapidly after HCO/MCO HD initiation, reaching 2400 mg/L by day 7, 1083 mg/L by day 14, and 370 mg/L by day 30. MCO HD achieved kapa FLC clearance comparable to HCO HD for the lambda isotype. Despite a median of only four HCO/MCO-HD sessions, the reduction in FLC was rapid, with an additional decline observed over time, while the median FLC concentration fell below 500 mg/L. At three months, the overall hematologic response was 87%, including very good partial response or better in 35% of patients, and renal response in 79% of patients. Achieving a ≥70% FLC reduction by day 7 was associated with superior outcomes, including markedly longer median overall survival (82.5 vs. 23.2 months). Conclusions: Our data show that HCO/MCO-HD treatment alongside anti-myeloma therapy achieves sustained FLC reduction in newly diagnosed MM with AKI and early FLC reduction is highlighted as a key determinant of survival. Full article
(This article belongs to the Special Issue Acute and Chronic Hemodialysis: Clinical Updates and Advances)
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