{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:41:04Z","timestamp":1747183264654,"version":"3.40.5"},"reference-count":11,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The introduction of high flux (HF) hemodialyzers and their application in single dialyzer hemodiafiltration (sdHDF) for patients on extracorporeal dialysis (ECD) therapy has improved the extraction of uremic toxins, including the low molecular weight protein (LMWP) beta 2 microglobulin (\u03b22M, 11.6\u2009kDa). Similar increases in the extraction of protein\u2010bound uremic toxins (PBUT) and larger LMWP (15\u201050\u2009kDa) remain elusive. High concomitant losses of albumin prohibit the use of medium cutoff (MCO) or protein\u2010losing hemodialyzers for sdHDF to increase the extraction of these molecules by convective transfer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A new extracorporeal dialysis treatment modality, dual dialyzer hemodiafiltration (ddHDF), has been designed together with a mathematical model to compare its predicted performance to that of sdHDF in the extraction of solute. The extra process that distinguishes ddHDF from sdHDF is the secondary ultrafiltration and partial reinfusion of the effluent hemodiafiltrate from the primary hemodialyzer. This allows MCO and protein\u2010losing hemodialyzers to be used to increase the extraction of both LMWP and PBUT without excessive concomitant loss of albumin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from the mathematical model show that ddHDF could increase the extraction of smaller and larger LMWP by an extra 102% and 220%, respectively, compared to standard HF sdHDF, while restricting the loss of albumin to 0.83 g per hour of treatment. In using albumin as a recyclable carrier molecule for the extraction of PBUT from plasma ddHDF has the potential to increase PBUT reduction ratios (RR's) to 49% by convection alone. Even higher RR's are possible if the dialysate volume flow rate can be increased beyond 600\u2009mL\/min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ddHDF provides an opportunity for a step change increase in the level of extraction of both larger LMWP and PBUT in patients with end\u2010stage kidney disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14555","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T06:58:41Z","timestamp":1682492321000},"page":"1514-1521","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dual dialyzer hemodiafiltration: A new extracorporeal dialysis treatment modality for patients with end\u2010stage kidney disease"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1219-9339","authenticated-orcid":false,"given":"Gerald","family":"Glancey","sequence":"first","affiliation":[{"name":"Renal Unit Ipswich Hospital, East Suffolk and North Essex Foundation Trust  Ipswich UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv318"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.13835"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins8120358"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins9020052"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02940509"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins7103933"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13248"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S102819"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep23389(2016)"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.05240418"},{"key":"e_1_2_6_12_1","first-page":"824","article-title":"The characterization of two specific binding sites on human serum albumin","volume":"11","author":"Sudlow G","year":"1975","journal-title":"Mol Pharmacol"}],"container-title":["Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aor.14555","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T13:42:04Z","timestamp":1695735724000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aor.14555"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,10]]},"references-count":11,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/aor.14555"],"URL":"https:\/\/doi.org\/10.1111\/aor.14555","archive":["Portico"],"relation":{},"ISSN":["0160-564X","1525-1594"],"issn-type":[{"type":"print","value":"0160-564X"},{"type":"electronic","value":"1525-1594"}],"subject":[],"published":{"date-parts":[[2023,5,10]]},"assertion":[{"value":"2023-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}