{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:42:33Z","timestamp":1792658553717,"version":"4.5.0"},"reference-count":61,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u03b22-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 \u03b22-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.<\/jats:p>","DOI":"10.3390\/jcm15051921","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T12:48:56Z","timestamp":1772542136000},"page":"1921","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Advances in Membrane, Dialyzer Design, and Related Monitoring Technologies for Hemodiafiltration: Translating Bench-Side Innovations to Bedside Applications"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7573-9833","authenticated-orcid":false,"given":"Alfred","family":"Gagel","sequence":"first","affiliation":[{"name":"Global Research and Development, Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Wiesen","sequence":"additional","affiliation":[{"name":"Global Research and Development, Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9546-4507","authenticated-orcid":false,"given":"Stefano","family":"Stuard","sequence":"additional","affiliation":[{"name":"Global Medical Office, Fresenius Medical Care, 26020 Palazzo Pignano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6854-2816","authenticated-orcid":false,"given":"Bernard","family":"Canaud","sequence":"additional","affiliation":[{"name":"School of Medicine & AIDER-Sant\u00e9, Montpellier University, Foundation Ch Mion, 34060 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Lang, T., Zawada, A.M., Theis, L., Braun, J., Ottillinger, B., Kopperschmidt, P., Gagel, A., Kotanko, P., Stauss-Grabo, M., and Kennedy, J.P. (2023). Hemodiafiltration: Technical and Medical Insights. Bioengineering, 10.","DOI":"10.3390\/bioengineering10020145"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Stuard, S., Maddux, F.W., and Canaud, B. (2025). Why High-Volume Post-Dilution Hemodiafiltration Should Be the New Standard in Dialysis Care: A Comprehensive Review of Clinical Outcomes and Mechanisms. J. Clin. Med., 14.","DOI":"10.20944\/preprints202506.0652.v1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.nefro.2016.05.013","article-title":"Protein-bound toxins: Added value in their removal with high convective volumes","volume":"36","author":"Abad","year":"2016","journal-title":"Nefrologia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/1744-9987.13508","article-title":"Super high-flux hemodialysis provides comparable effectiveness with high-volume postdilution online hemodiafiltration in removing protein-bound and middle-molecule uremic toxins: A prospective cross-over randomized controlled trial","volume":"25","author":"Thammathiwat","year":"2021","journal-title":"Ther. Apher. Dial."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1007\/s40620-022-01283-3","article-title":"High-volume hemodiafiltration decreases the pre-dialysis concentrations of indoxyl sulfate and p-cresyl sulfate compared to hemodialysis: A post-hoc analysis from the HDFit randomized controlled trial","volume":"35","author":"Lima","year":"2022","journal-title":"J. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1159\/000346379","article-title":"Achieving high convective volumes in on-line hemodiafiltration","volume":"35","author":"Bowry","year":"2013","journal-title":"Blood Purif."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1038\/ki.2015.139","article-title":"Optimal convection volume for improving patient outcomes in an international incident dialysis cohort treated with online hemodiafiltration","volume":"88","author":"Canaud","year":"2015","journal-title":"Kidney Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1159\/000450634","article-title":"What Is the Optimal Target Convective Volume in On-Line Hemodiafiltration Therapy?","volume":"189","author":"Canaud","year":"2017","journal-title":"Contrib. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Group ObotEW (2002). II.2 Haemodialysis dose quantification: Middle molecules (MM). Nephrol. Dial. Transplant., 17, 21\u201323.","DOI":"10.1093\/ndt\/17.suppl_7.21"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1056\/NEJMoa2304820","article-title":"Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure","volume":"389","author":"Blankestijn","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1016\/S0140-6736(24)01859-2","article-title":"Haemodiafiltration versus haemodialysis for kidney failure: An individual patient data meta-analysis of randomised controlled trials","volume":"404","author":"Vernooij","year":"2024","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1093\/ndt\/gfv349","article-title":"Haemodiafiltration and mortality in end-stage kidney disease patients: A pooled individual participant data analysis from four randomized controlled trials","volume":"31","author":"Peters","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Winter, A., Ferreras, B.A., Carioni, P., Arkossy, O., Anger, M., Kossmann, R., Usvyat, L.A., Stuard, S., and Maddux, F.W. (2025). Real-world effectiveness of hemodialysis modalities: A retrospective cohort study. BMC Nephrol., 26.","DOI":"10.1186\/s12882-024-03934-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1053\/j.ajkd.2025.04.013","article-title":"Mortality on Hemodiafiltration Compared to High-Flux Hemodialysis: A Brazilian Cohort Study","volume":"86","author":"Canziani","year":"2025","journal-title":"Am. J. Kidney Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ronco, C., Maduell, F., Kalantar-Zadeh, K., Madero, M., and Reis, T. (2025). The Role of Online Hemodiafiltration in Contemporary Kidney Care. Clin. J. Am. Soc. Nephrol., Epub ahead of print.","DOI":"10.2215\/CJN.0000000920"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1097\/MNH.0000000000000744","article-title":"Recent advances in dialysis membranes","volume":"30","author":"Canaud","year":"2021","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wanner, C., Vanholder, R., Ortiz, A., Davenport, A., Canaud, B., Blankestijn, P.J., Masereeuw, R., Kooman, J.P., Castellano, G., and Stamatialis, D. (2024). Proceedings of a membrane update symposium: Advancements, scientific insights, and future trends for dialysis membranes for enhanced clinical outcomes in end stage kidney disease patients. Front. Nephrol., 4.","DOI":"10.3389\/fneph.2024.1455260"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1038\/s41581-018-0002-x","article-title":"Haemodialysis membranes","volume":"14","author":"Ronco","year":"2018","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/ndt\/13.suppl_5.3","article-title":"On-line haemodiafiltration: State of the art","volume":"13","author":"Canaud","year":"1998","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1177\/039139880102401005","article-title":"Nanoscale modulation of the pore dimensions, size distribution and structure of a new polysulfone-based high-flux dialysis membrane","volume":"24","author":"Ronco","year":"2001","journal-title":"Int. J. Artif. Organs"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S126","DOI":"10.1046\/j.1523-1755.61.s80.23.x","article-title":"Hemodialyzer: From macro-design to membrane nanostructure; the case of the FX-class of hemodialyzers","volume":"80","author":"Ronco","year":"2002","journal-title":"Kidney Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"iii41","DOI":"10.1093\/ndt\/gfy202","article-title":"Expanded haemodialysis: From operational mechanism to clinical results","volume":"33","author":"Ronco","year":"2018","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"20543581211067090","DOI":"10.1177\/20543581211067090","article-title":"Effects of Medium Cut-Off Versus High-Flux Hemodialysis Membranes on Biomarkers: A Systematic Review and Meta-Analysis","volume":"9","author":"Kandi","year":"2022","journal-title":"Can. J. Kidney Health Dis."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zickler, D., Schindler, R., Willy, K., Martus, P., Pawlak, M., Storr, M., Hulko, M., Boehler, T., Glomb, M.A., and Liehr, K. (2017). Medium Cut-Off (MCO) Membranes Reduce Inflammation in Chronic Dialysis Patients-A Randomized Controlled Clinical Trial. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0169024"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Hornig, C., Bowry, S.K., Kircelli, F., Kendzia, D., Apel, C., and Canaud, B. (2024). Hemoincompatibility in Hemodialysis-Related Therapies and Their Health Economic Perspectives. J Clin Med., 13.","DOI":"10.3390\/jcm13206165"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1159\/000333287","article-title":"Polysulfone: The development of a membrane for convective therapies","volume":"175","author":"Heilmann","year":"2011","journal-title":"Contrib. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1159\/000333291","article-title":"Membrane requirements for high-flux and convective therapies","volume":"175","author":"Bowry","year":"2011","journal-title":"Contrib. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Zawada, A.M., Emal, K., F\u00f6rster, E., Saremi, S., Delinski, D., Theis, L., K\u00fcng, F., Xie, W., Werner, J., and Stauss-Grabo, M. (2024). Hydrophilic Modification of Dialysis Membranes Sustains Middle Molecule Removal and Filtration Characteristics. Membranes, 14.","DOI":"10.3390\/membranes14040083"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/hdi.12939","article-title":"Polyvinylpyrrolidone in hemodialysis membranes: Impact on platelet loss during hemodialysis","volume":"25","author":"Zawada","year":"2021","journal-title":"Hemodial. Int."},{"key":"ref_30","first-page":"269","article-title":"Comparison of dialyzers in on-line hemodiafiltration","volume":"20","author":"Maduell","year":"2000","journal-title":"Nefrologia"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"iii22","DOI":"10.1093\/ndt\/gfy228","article-title":"Membrane innovation: Closer to native kidneys","volume":"33","author":"Storr","year":"2018","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/j.1525-1594.1995.tb02353.x","article-title":"Theoretical description of mass transport in medical membrane devices","volume":"19","author":"Werynski","year":"1995","journal-title":"Artif. Organs"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"sfae147","DOI":"10.1093\/ckj\/sfae147","article-title":"Does online high-volume hemodiafiltration offer greater efficiency and sustainability compared with high-flux hemodialysis? A detailed simulation analysis anchored in real-world data","volume":"17","author":"Canaud","year":"2024","journal-title":"Clin. Kidney J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1159\/000333626","article-title":"Backfiltration: Past, present and future","volume":"175","author":"Rangel","year":"2011","journal-title":"Contrib. Nephrol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/039139889001300103","article-title":"Backfiltration in clinical dialysis: Nature of the phenomenon, mechanisms and possible solutions","volume":"13","author":"Ronco","year":"1990","journal-title":"Int. J. Artif. Organs"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1046\/j.1523-1755.1998.00049.x","article-title":"Enhancement of convective transport by internal filtration in a modified experimental hemodialyzer: Technical note","volume":"54","author":"Ronco","year":"1998","journal-title":"Kidney Int."},{"key":"ref_37","unstructured":"International Organization for Standardization (2019). ISO 23500 Series: Ensuring Quality of Fluids for Hemodialysis and Related Therapies, ISO Central Secretariat."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1177\/039139880202500307","article-title":"In vitro evaluation of the hydraulic permeability of polysulfone dialysers","volume":"25","author":"Eloot","year":"2002","journal-title":"Int. J. Artif. Organs"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"76","DOI":"10.5301\/ijao.5000389","article-title":"Factors associated with albumin loss in post-dilution hemodiafiltration and nutritional consequences","volume":"38","author":"Fournier","year":"2015","journal-title":"Int. J. Artif. Organs"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1038\/ki.1986.202","article-title":"Permeability and secondary membrane formation of a high flux polysulfone hemofilter","volume":"30","author":"Hertel","year":"1986","journal-title":"Kidney Int."},{"key":"ref_41","unstructured":"(1996). Haemodialysers, Haemodiafilters, Haemofilters, Haemoconcentrators and Their Extracorporeal Circuits (Standard No. EN 1283)."},{"key":"ref_42","unstructured":"(2024). Extracorporeal Systems for Blood Purification Part 1: Haemodialysers, Haemodiafilters, Haemofilters and Haemoconcentrators (Standard No. ISO 8637-1)."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1097\/MAT.0000000000001074","article-title":"Quantifying the Effect of Plasma Viscosity on In Vivo Dialyzer Performance","volume":"66","author":"Schneditz","year":"2020","journal-title":"ASAIO J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.ekir.2020.11.020","article-title":"Arterial Versus Venous Port Site Administration of Nadroparin for Preventing Thrombosis of Extracorporeal Blood Circuits in Patients Receiving Hemodiafiltration Treatment","volume":"6","author":"Hebibi","year":"2021","journal-title":"Kidney Int. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1113\/jphysiol.1896.sp000596","article-title":"On the Absorption of Fluids from the Connective Tissue Spaces","volume":"19","author":"Starling","year":"1896","journal-title":"J. Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1620\/tjem.135.43","article-title":"The corrected protein equation to estimate plasma colloid osmotic pressure and its development on a nomogram","volume":"135","author":"Nitta","year":"1981","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_47","first-page":"961","article-title":"Exchange of substances through the capillary walls","volume":"Volume II","author":"Landis","year":"1963","journal-title":"Handbook of Physiology Circulation"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1111\/aor.13081","article-title":"The Influence of Colloid Osmotic Pressure on Hydrostatic Pressures in High- and Low-Flux Hemodialyzers","volume":"42","author":"Schneditz","year":"2018","journal-title":"Artif. Organs"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4103\/0971-4065.82139","article-title":"Effect of changes in the intravascular volume during hemodialysis on blood viscoelasticity","volume":"21","author":"Metry","year":"2011","journal-title":"Indian J. Nephrol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1038\/sj.ki.5000447","article-title":"Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS","volume":"69","author":"Canaud","year":"2006","journal-title":"Kidney Int."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1681\/ASN.2011121140","article-title":"Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes","volume":"23","author":"Grooteman","year":"2012","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1093\/ndt\/gfs407","article-title":"Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: Results from the Turkish OL-HDF Study","volume":"28","author":"Ok","year":"2013","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1681\/ASN.2012080875","article-title":"High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients","volume":"24","author":"Maduell","year":"2013","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1038\/ki.2015.264","article-title":"Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: The effect of adjustment for body size","volume":"89","author":"Davenport","year":"2016","journal-title":"Kidney Int."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Pedreros-Rosales, C., Jara, A., Lorca, E., Mezzano, S., Pecoits-Filho, R., and Herrera, P. (2023). Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond. Toxins, 15.","DOI":"10.3390\/toxins15090531"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Gayrard, N., Ficheux, A., Duranton, F., Guzman, C., Szwarc, I., Vetromile, F., Cazevieille, C., Brunet, P., Servel, M.-F., and Argil\u00e9s, \u00c0. (2017). Consequences of increasing convection onto patient care and protein removal in hemodialysis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0171179"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1093\/ndt\/gfw310","article-title":"Performance of hemodialysis with novel medium cut-off dialyzers","volume":"32","author":"Kirsch","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1093\/ckj\/sfy004","article-title":"Evaluation of the efficacy of a medium cut-off dialyser and comparison with other high-flux dialysers in conventional haemodialysis and online haemodiafiltration","volume":"11","author":"Vega","year":"2018","journal-title":"Clin. Kidney J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1152\/physrev.1969.49.4.863","article-title":"Rheology of blood","volume":"49","author":"Errill","year":"1969","journal-title":"Physiol. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"E280","DOI":"10.1111\/aor.13923","article-title":"Quantitative assessment of sodium mass removal using ionic dialysance and sodium gradient as a proxy tool: Comparison of high-flux hemodialysis versus online hemodiafiltration","volume":"45","author":"Rodriguez","year":"2021","journal-title":"Artif. Organs"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1177\/03913988241296699","article-title":"The Donnan equilibrium is still valid in high-volume HDF","volume":"47","author":"Gross","year":"2024","journal-title":"Int. J. Artif. Organs"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1921\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T13:33:51Z","timestamp":1772544831000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":61,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051921"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051921","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]}}}