{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:10:35Z","timestamp":1791612635540,"version":"4.3.4"},"reference-count":51,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"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":["Seminars in Dialysis"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Expanded hemodialysis (HDx) represents a transformative innovation in renal replacement therapy, addressing the limitations of conventional hemodialysis and high\u2010flux modalities. By employing medium cut\u2010off (MCO) membranes, HDx ensures efficient clearance of middle\u2010 and large\u2010molecular\u2010weight uremic toxins, such as \u03b2<jats:sub>2<\/jats:sub>\u2010microglobulin and cytokines, while selectively retaining vital proteins like albumin. This comprehensive review examines the clinical efficacy, safety, and broader implications of HDx, highlighting its potential to improve outcomes for patients with chronic kidney disease (CKD). The review synthesizes findings from comparative studies, emphasizing HDx's superior toxin removal capabilities, particularly for solutes implicated in systemic inflammation and cardiovascular complications. Key mechanisms, including the internal filtration\u2013backfiltration process, contribute to hemodynamic stability and enhanced toxin clearance. HDx demonstrates significant reductions in inflammatory biomarkers, improved arterial compliance, and better cardiovascular outcomes compared with traditional methods. Patient\u2010reported outcomes further underscore HDx's benefits, with shorter recovery times, enhanced quality of life, and reduced intradialytic complications. While albumin loss remains a consideration, studies confirm its clinical acceptability and minimal impact on nutritional status. HDx's economic viability, reduced infrastructure requirements, and compatibility with existing systems position it as a cost\u2010effective alternative, especially in resource\u2010limited settings. Despite promising evidence, the review identifies gaps in long\u2010term data, particularly regarding mortality and sustained quality\u2010of\u2010life improvements. Future directions include refining membrane technologies and incorporating personalized medicine approaches to optimize HDx protocols. By bridging these gaps, HDx has the potential to redefine renal replacement therapy, offering a safer, more effective, and scalable solution for CKD management.<\/jats:p>","DOI":"10.1111\/sdi.13257","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T05:15:09Z","timestamp":1744866909000},"page":"176-186","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Multidimensional Impact of Expanded Hemodialysis: A Comprehensive Review"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7973-6915","authenticated-orcid":false,"given":"Georges","family":"Kosmadakis","sequence":"first","affiliation":[{"name":"AuraSant\u00e9  Clermont Ferrand France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aura","family":"Necoara","sequence":"additional","affiliation":[{"name":"AuraSant\u00e9  Clermont Ferrand France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Baudenon","sequence":"additional","affiliation":[{"name":"AuraSant\u00e9  Clermont Ferrand France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemence","family":"Deville","sequence":"additional","affiliation":[{"name":"AuraSant\u00e9  Clermont Ferrand France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Enache","sequence":"additional","affiliation":[{"name":"AuraSant\u00e9  Clermont Ferrand France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Chelaru","sequence":"additional","affiliation":[{"name":"AuraSant\u00e9  Clermont Ferrand France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30045-3"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins13040246"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021583"},{"issue":"3","key":"e_1_2_11_5_1","first-page":"220","article-title":"Role of High\u2010Flux Membranes in Hemodialysis: Facts and Myths","volume":"47","author":"Stadler T.","year":"2019","journal-title":"Blood Purification"},{"issue":"3","key":"e_1_2_11_6_1","first-page":"222","article-title":"Inflammation and Mortality: A New Approach to an Old Problem","volume":"47","author":"Kooman J. 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