{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:25:24Z","timestamp":1782883524109,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ther Apher Dial"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Chronic micro\u2010inflammation in patients with end\u2010stage renal disease (ESRD) is a significant driver of cardiovascular complications and diminished quality of life. While standard hemodialysis (SHD) effectively manages small\u2010molecule clearance, its ability to remove medium\u2010to\u2010large uremic toxins\u2014the primary catalysts of systemic inflammation\u2014remains limited. This study aimed to evaluate the comparative clinical benefits of hemodiafiltration (HDF) and hemoperfusion (HDP) relative to SHD, specifically focusing on inflammatory control, dialysis adequacy, and patient safety.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a 10\u2010week, single\u2010center, non\u2010randomized prospective observational study evaluating 365 end\u2010stage renal disease (ESRD) patients divided into three cohorts: standard hemodialysis (SHD,\n n<\/jats:italic>\n \u2009=\u2009145, thrice\u2010weekly), online hemodiafiltration (HDF,\n n<\/jats:italic>\n \u2009=\u2009115, twice\u2010weekly hemodialysis plus once\u2010weekly HDF), and hemoperfusion (HDP,\n n<\/jats:italic>\n \u2009=\u2009105, twice\u2010weekly hemodialysis plus once\u2010monthly hemoperfusion). Primary endpoints were restricted to short\u2010term surrogate outcomes, including shifts in serum inflammatory markers (interleukin\u20106 (IL\u20106), tumor necrosis factor\u2010alpha (TNF\u2010\n \u03b1<\/jats:italic>\n ), C\u2010reactive protein (CRP)) and clearance adequacy indices (Kt\/V, URR).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Baseline characteristics were well\u2010balanced across all three cohorts. Following 10\u2009weeks of treatment, the HDF (84.2%) and HDP (77.1%) groups demonstrated significantly higher effective treatment rates (defined by clinical symptom improvement and biochemical stability, a composite of symptomatic improvement and biochemical stability) compared to the SHD group (61.4%;\n p<\/jats:italic>\n \u2009<\u20090.05). Advanced modalities achieved increased association with biomarker reduction of middle\u2010molecule toxins, with HDF showing the most profound reductions in IL\u20106, TNF\u2010\n \u03b1<\/jats:italic>\n , and CRP (\n p<\/jats:italic>\n \u2009<\u20090.001). Dialysis adequacy was significantly improved in the HDF group, which showed the highest increases in dialysis adequacy. While the incidence of acute complications such as hypotension and muscle cramps did not differ significantly between groups, both HDF and HDP cohorts reported a notable reduction in post\u2010dialysis fatigue compared to SHD (14% and 16% vs. 19%, respectively). However, HDF and HDP cohorts experienced lower incidences of cognitive dysfunction.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Over a 10\u2010week observation framework, advanced hybrid modalities (HDF and HDP) are independently associated with superior clearance of middle\u2010to\u2010large molecular uremic toxins and attenuated systemic inflammation compared to SHD. However, these short\u2010term surrogate improvements did not translate into a statistically significant reduction in clinical adverse events or post\u2010dialysis fatigue, indicating the need for long\u2010term longitudinal evaluation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/1744-9987.70178","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T04:15:48Z","timestamp":1782879348000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Evaluation of Hemodiafiltration, Hemoperfusion, and Standard Hemodialysis on Efficacy, Inflammatory Control, Dialysis Adequacy, and Safety in End\u2010Stage Renal Disease: A Prospective Observational Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7508-8447","authenticated-orcid":false,"given":"Hongwei","family":"Zuo","sequence":"first","affiliation":[{"name":"Department of Nephrology Chongqing University FuLing Hospital Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7349-0843","authenticated-orcid":false,"given":"Weisi","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Nephrology Chongqing University FuLing Hospital Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6963-7751","authenticated-orcid":false,"given":"Jie","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Nephrology Chongqing University FuLing Hospital Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0905-1544","authenticated-orcid":false,"given":"Mei","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Nephrology Chongqing University FuLing Hospital Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2266-6033","authenticated-orcid":false,"given":"Xingshan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Nephrology Chongqing University FuLing Hospital Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6673-6229","authenticated-orcid":false,"given":"Xiaocui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nephrology Chongqing University FuLing Hospital Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"issue":"10518","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1016\/S0140-6736(25)01853-7","article-title":"Global, Regional, and National Burden of Chronic Kidney Disease in Adults, 1990\u20132023, and Its Attributable Risk Factors: A 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J.","year":"2023","journal-title":"New England Journal of Medicine"},{"issue":"5","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/j.kint.2024.07.014","article-title":"The CONVINCE Randomized Trial Found Positive Effects on Quality of Life for Patients With Chronic Kidney Disease Treated With Hemodiafiltration","volume":"106","author":"Rose M.","year":"2024","journal-title":"Kidney International"},{"issue":"10321","key":"e_1_2_12_11_1","first-page":"1022","article-title":"Haemodiafiltration Versus Haemodialysis for Kidney Failure: Individual Patient Data Meta\u2010Analysis","volume":"405","author":"Vernooij R. W. 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Y.","year":"2020","journal-title":"Korean Journal of Anesthesiology"},{"issue":"1","key":"e_1_2_12_25_1","first-page":"1","article-title":"Effect of Hemodiafiltration and Hemodialysis on Mortality of Patients With End\u2010Stage Kidney Disease: A Meta\u2010Analysis","volume":"25","author":"Zhu Y.","year":"2024","journal-title":"BMC Nephrology"},{"issue":"3","key":"e_1_2_12_26_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.5152\/turkjnpehrol.2019.3426","article-title":"Evaluation of Hemodialysis Adequacy: Correlation Between Kt\/Vurea and Other Methods","volume":"28","author":"Balo\u011flu \u0130.","year":"2019","journal-title":"Turkish Journal of Nephrology"},{"key":"e_1_2_12_27_1","article-title":"Comparison of Combined Hemodialysis and Hemoperfusion With Hemoperfusion Alone in 106 Patients With Diabetic Ketoacidosis and Acute Renal Failure: A Retrospective Study From a Single Center in China","volume":"27","author":"Wang G.","year":"2021","journal-title":"Medical Science Monitor"},{"issue":"2","key":"e_1_2_12_28_1","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.kint.2018.09.024","article-title":"Sodium and Water Handling During Hemodialysis: New Pathophysiologic Insights and Management Approaches for Improving Outcomes in End\u2010Stage Kidney Disease","volume":"95","author":"Canaud B.","year":"2019","journal-title":"Kidney International"}],"container-title":["Therapeutic Apheresis and Dialysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1744-9987.70178","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1744-9987.70178","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1744-9987.70178","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T04:15:53Z","timestamp":1782879353000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1744-9987.70178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":27,"alternative-id":["10.1002\/1744-9987.70178"],"URL":"https:\/\/doi.org\/10.1002\/1744-9987.70178","archive":["Portico"],"relation":{},"ISSN":["1744-9979","1744-9987"],"issn-type":[{"value":"1744-9979","type":"print"},{"value":"1744-9987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]},"assertion":[{"value":"2026-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1744-9987.70178"}}