{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"NephSpace","title":"Deep Dive · Two Roads: Hemodiafiltration or Medium Cutoff Dialyzers?","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/5b3a2d4e\"></iframe>","width":"100%","height":180,"duration":1211,"description":"Two dialysis patients, same city, same week. One gets a new machine that filters and replaces more than 20 liters every session. The other gets the same old machine with a new filter. Both are told it's the future. Hemodiafiltration has a survival trial but needs new machines. Medium cutoff dialyzers drop into today's machines but have no survival evidence against standard dialysis. A detective story with a Fight Night verdict, including who makes, sells and funds each road.\n\nThe takeaway: Both roads clear more middle molecules, but only hemodiafiltration has shown that people live longer, and only in patients who can get the dose.\n\nDisclosure: Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. Fresenius makes and sells the 5008X hemodiafiltration machine discussed in this episode. The episode names the industry ties of the review authors and of everyone quoted.\n\nChapters\n00:00 Cold open and disclosure\n01:11 The mystery: what middle molecules are, and why clearing them might matter\n02:47 Road one, change the treatment: CONVINCE, its quality-of-life and cost papers, and the JASN review\n08:36 Road two, change the filter: Theranova, ELISIO-HX and the medium cutoff evidence\n11:47 The showdown: MOTheR, the head-to-head trial\n15:13 Follow the money: who makes, sells and funds each road\n16:49 Fight Night verdict and the Monday-morning change\n\nPapers discussed\nBlankestijn PJ, et al. Hemodiafiltration: Clinical Practice of Today and a Look into the Future. JASN 2026 (ahead of print). https://doi.org/10.1681/ASN.0000001282\nHealio | Nephrology, September 24, 2026. Q&A with DaVita's chief medical officer on medium cutoff dialyzers. https://www.healio.com/news/nephrology/20260924/qa-recent-fda-approval-prompts-expansion-of-medium-cutoff-dialyzers\nBlankestijn PJ, et al. Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure (CONVINCE). N Engl J Med 2023;389:700-709. https://doi.org/10.1056/NEJMoa2304820\nRose M, et al. CONVINCE...","thumbnail_url":"https://img.transistorcdn.com/qEB_C2DMBeK5C7ck76pmhOTj2_OsMU1iYzmZ4jzilE8/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9kZDYw/YjRhODU0MTA5MDRj/Y2YwNTQ3OThmNzE5/YmI4ZC5qcGc.webp","thumbnail_width":300,"thumbnail_height":300}