Comparative Analysis of the ELISIO-HX and Xevonta-Hi Dialyzers in Standard Hemodialysis

Abstract

As chronic kidney disease (CKD) prevalence rises, optimizing hemodialysis remains essential. While online hemodiafiltration (OL-HDF) is the gold standard, expanded hemodialysis (HDx), i.e., using high-performance dialyzers in standard hemodialysis, remains the most common clinical practice. Medium cutoff (MCO) membranes aim to enhance middle-molecule removal while preserving protein selectivity, although most studies evaluate them in OL-HDF. To this end, this study aims to compare the Xevonta-Hi (B. Braun), a high-flux (HF) polysulfone dialyzer, and the ELISIO-HX (Nipro), an MCO polyethersulfone dialyzer, in standard hemodialysis. In a prospective, observational study, seven stable patients sequentially received treatment with each dialyzer over four weeks. Pre- and post-dialysis levels of small and middle uremic molecules and inflammatory markers-including procalcitonin, prolactin, serum amyloid A, placental growth factor, interleukin-6, haptoglobin, ceruloplasmin, transferrin, prealbumin, and C-reactive protein-were measured. Both dialyzers demonstrated excellent clearance of small and middle molecules, with no significant differences in efficacy. Albumin and total protein losses remained minimal. Moderate reductions in serum amyloid A, placental growth factor, and interleukin-6 were observed, while no significant reductions occurred in the remaining inflammatory markers. These findings support the safety and effectiveness of both MCO and HF dialyzers in standard hemodialysis.

Keywords: expanded hemodialysis (HDx); high-flux dialyzers; inflammatory markers; medium cutoff (MCO) membranes; standard hemodialysis; uremic toxin clearance.

Figure 1

Schematic representation of the study design.

Figure 2

Reduction ratios (RRs%) of small and middle molecules. Small molecules (molecular weight < 500 Da): urea (60 Da), creatinine (113 Da), phosphorus (30 Da), potassium (39 Da), sodium (23 Da), and calcium (40 Da). Middle molecules (molecular weight 500 Da–60 kDa): β2-microglobulin (12 kDa), parathyroid hormone (PTH) (9.4 kDa), procalcitonin (13 kDa), and prolactin (23 kDa). Comparisons of RRs% between dialyzers were made using the Mann–Whitney U test for unpaired samples (95% Confidence Interval).

Figure 3

Reduction ratios (RRs%) of inflammatory markers. Inflammatory markers: transferrin, ceruloplasmin, haptoglobin, prealbumin, C-reactive protein, interleukin-6, placental growth factor (PLGF), and serum amyloid A. Comparisons of RRs% between dialyzers were made using the Mann–Whitney U test for unpaired samples (95% Confidence Interval).