Hemoadsorption Combined with Hemodialysis (HAHD): a Consensus Statement from an International Expert Panel

Clinical outcomes in patients on maintenance dialysis are still unsatisfactory. Despite delivery of adequate dialysis, residual symptoms and signs of uremic intoxication are often present, such as pruritus and xeroderma, restless leg syndrome, sleep disorders, cognitive impairment, anxiety and depression, cramps, fatigue, and muscular weakness, mineral and bone disorders, cardiovascular complications, chronic inflammation, and accelerated atherosclerosis. These have been correlated with retention of inflammatory chemical mediators, protein-bound uremic toxins, and middle to large molecular weight toxins that are insufficiently cleared by current dialysis techniques. A new extracorporeal technique combining hemoadsorption with hemodialysis (HAHD) has been utilized with promising results but enormous variability of procedures, resulting in limited evidence. Previous experience in incorporating innovative approaches has demonstrated that, after several years of pioneering work, a common pathway is necessary to generate sufficient evidence, spanning from case reports, expert debates, retrospective and observational studies, registries, and underpowered trials to multicenter international randomized clinical trials and meta-analyses. Thus, the widespread adoption of HAHD requires the application of implementation science techniques supported by healthcare policies. The scope of this conference is to conduct an objective appraisal of current knowledge and to propose a standardized application modality, enabling the design of comparable clinical trials and the acquisition of homogeneous datasets suitable for evaluation and discussion.

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Publication Details

Journal
Nephrology Dialysis Transplantation
Published
2026-03-02
DOI
https://doi.org/10.1093/ndt/gfag046
Primary Topic
Dialysis and Renal Disease Management
Type
article
Field-Weighted Citation Impact
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article

Hemoadsorption Combined with Hemodialysis (HAHD): a Consensus Statement from an International Expert Panel

Jonny Lau, Dimitris Petras, Laurent Juillard, Gerasimos I. Bamihas et al.
Nephrology Dialysis Transplantation
Dialysis and Renal Disease Management
article

Hemoadsorption Combined with Hemodialysis (HAHD): a Consensus Statement from an International Expert Panel

Jonny Lau, Dimitris Petras, Laurent Juillard, Gerasimos I. Bamihas, Anna Lorenzin, M. Ostermann, Guangyan Cai, Alessandra Brendolan, Lynn A Gomez, Rajasekara Chakravarthi, Ghada Ankawi, Huu Dung Nguyen, Thiago Reis, Matteo Floris, Faeq Husain-Syed, Gonzalo Ramírez-Guerrero, Mario Cozzolino, Xiaoqiang Ding, Jolanta Małyszko, Vincenzo Cantaluppi, Hongli Lin, Francisco Maduell, Claudio Ronco
article en

Abstract

Clinical outcomes in patients on maintenance dialysis are still unsatisfactory. Despite delivery of adequate dialysis, residual symptoms and signs of uremic intoxication are often present, such as pruritus and xeroderma, restless leg syndrome, sleep disorders, cognitive impairment, anxiety and depression, cramps, fatigue, and muscular weakness, mineral and bone disorders, cardiovascular complications, chronic inflammation, and accelerated atherosclerosis. These have been correlated with retention of inflammatory chemical mediators, protein-bound uremic toxins, and middle to large molecular weight toxins that are insufficiently cleared by current dialysis techniques. A new extracorporeal technique combining hemoadsorption with hemodialysis (HAHD) has been utilized with promising results but enormous variability of procedures, resulting in limited evidence. Previous experience in incorporating innovative approaches has demonstrated that, after several years of pioneering work, a common pathway is necessary to generate sufficient evidence, spanning from case reports, expert debates, retrospective and observational studies, registries, and underpowered trials to multicenter international randomized clinical trials and meta-analyses. Thus, the widespread adoption of HAHD requires the application of implementation science techniques supported by healthcare policies. The scope of this conference is to conduct an objective appraisal of current knowledge and to propose a standardized application modality, enabling the design of comparable clinical trials and the acquisition of homogeneous datasets suitable for evaluation and discussion.

Nephrology Dialysis Transplantation
Université Claude Bernard Lyon 1 (FR), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), St Thomas' Hospital (GB), University of Padua (IT), University of Cagliari (IT), Universidade de São Paulo (BR), King Abdulaziz University (SA), University of Milan (IT), Dalian Medical University (CN), Justus-Liebig-Universität Gießen (DE), Fudan University (CN), Medical University of Warsaw (PL), Universitätsklinikum Gießen und Marburg (DE), Gatot Soebroto Army Hospital (ID), Philippine General Hospital (PH), Chinese PLA General Hospital (CN), Hôpital de la Croix-Rousse (FR), Hospices Civils de Lyon (FR), Centro Paulista de Investigação Clinica (BR), Indonesia Defense University (ID), Hospital Clínic de Barcelona (ES), Zhongshan Hospital (CN), Yashoda Hospital (IN), First Affiliated Hospital of Dalian Medical University (CN), Ospedale San Bortolo (IT), Bạch Mai Hospital (VN), Piedmont University (US), G. Papanikolaou General Hospital (GR), International Renal Research Institute of Vicenza (IT), Hospital Las Higueras (CL), Hippocration General Hospital (GR), Azienda Ospedaliera G. Brotzu (IT), KU Leuven (BE)
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Dialysis and Renal Disease Management
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