U.S. Renal Care Drives Innovation in Dialysis with Increased Availability of Medium Cut-Off Dialyzers to Support Expanded Hemodialysis

Growing body of evidence suggests that these therapies improve outcomes and quality of life for people living with end stage kidney disease receiving hemodialysis

PLANO, Texas, July 30, 2026 /PRNewswire/ -- U.S. Renal Care (USRC), the nation's largest privately held and fastest-growing kidney care provider, remains on the leading edge of kidney care innovation with its announcement of increased availability of medium cut-off (MCO) dialyzers to support Expanded Hemodialysis (HDx) for eligible patients. Data shows that these advanced therapies enhance middle molecule clearance, leading to improved outcomes and quality of life for patients, including improved sleep, post-treatment recovery, cognitive function, and itching or restless legs.

"The results of the MOTheR trial¹ and CONCORDIA² study presented at the 2026 European Renal Association meeting help shape an advancement in the treatment of ESKD with hemodialysis," said Mary Dittrich, MD, FASN, U.S. Renal Care's Chief Medical Officer. "Evidence continues to accumulate which demonstrates the clinical benefits of HDx with MCO dialyzers, and we believe it is essential to make this therapy available to eligible patients and are proud to do so. Through prospectively designed registries, we will continue to rigorously evaluate clinical outcomes to further extend the evidence base for HDx as compared to high-flux hemodialysis." 

Expanded Hemodialysis (HDx) with Medium Cut-Off (MCO) Dialyzers vs. Standard High-Flux Hemodialysis
Expanded hemodialysis refers to hemodialysis performed on standard dialysis machines with a medium cut-off (MCO) dialyzer that provides increased convective clearance versus standard high-flux hemodialysis. MCO dialyzers, such as Theranova and ELISIO-HX, use next-generation membranes with larger and more uniform pores designed to enhance removal of medium to large middle-molecules, which have consistently been associated with inflammation, cardiovascular complications, and poorer quality of life in patients receiving maintenance dialysis.

Standard high-flux hemodialysis effectively removes small solutes but has limited ability to clear larger middle molecules. MCO dialyzers expand the range of solute removal, allowing clearance of molecules up to approximately 60 kDa. For many clinically relevant middle molecules, MCO dialyzers achieve clearance that is comparable to high-volume hemodiafiltration, while avoiding the additional technical complexity and infrastructure demands of HDF³.

Additional Evidence-Supported Potential Benefits of HDx with MCO Dialyzers

• Albumin stability: MCO membranes result in reduced albumin loss as compared to HDF and studies show that any early albumin reduction is generally small and transient, with serum albumin returning to baseline over time and without clear adverse nutritional consequences^4,5.
• Patient-reported outcomes: Observational studies and randomized data suggest improvements in symptom burden, including energy, sleep quality, pruritus, pain, restless legs, mood, and post-dialysis recovery time for patients using MCO dialyzers^6-9.
• Residual kidney function: In incident hemodialysis patients, HDx with Theranova has been associated with better preservation of residual kidney function, including slower decline in GFR and maintenance of urine volume¹⁰.
• Hospitalization and cost outcomes: A U.S. post-hoc economic analysis found fewer hospitalizations and lower total costs among patients treated with HDx using Theranova compared with standard high-flux HD¹¹.
• Clinical outcomes comparable to HDF: The evidence supporting HDx has strengthened substantially. Most recently, results from the MOTheR trial were presented at the European Renal Association meeting. This randomized trial compared HDx with medium cut-off dialyzers to online hemodiafiltration (HDF) and met its primary noninferiority endpoint for a composite of all-cause mortality and major cardiovascular events. Serious adverse event rates were similar between groups. In parallel, interim results from the CONCORDIA real-world observational analysis also reported comparable survival outcomes between HDx and HDF. Taken together, these data support HDx as a practical approach to enhanced middle-molecule clearance that can be delivered on existing hemodialysis machines without the infrastructure requirements of online HDF¹².

MCO dialyzers are currently available in selected centers within U.S. Renal Care and Satellite Healthcare, and broader availability will be coming to additional centers.

About U.S. Renal Care
U.S. Renal Care is the largest privately held and fastest-growing dialysis provider in the nation. We partner with nephrologists to care for more than 37,000 people living with kidney disease across 32 states, offering in-center and home dialysis options that support each patient's unique lifestyle and care needs. U.S. Renal Care leads the dialysis industry with the highest percentage of CMS 4- and 5-star rated centers for patient experience and quality of care. U.S. Renal Care's Kidney Research team designs and conducts clinical trials, spanning across academic collaboration, investigator-initiated research, industry-sponsored research, and federally-funded research. Since 2000, U.S. Renal Care has grown through clinical excellence, innovation and a shared commitment to improving the lives of people with kidney disease. Visit USRenalCare.com to learn more. 

References

¹ de Sequera P, et al. MOTheR HDx study: a multicentre, open-label, prospective, randomized study to explore morbidity and mortality in patients dialyzed with Theranova HDx compared with online haemodiafiltration [abstract 27]. Presented at: 63rd Congress of the European Renal Association; June 3–6, 2026; Glasgow, UK. Late-Breaking Clinical Trials session.

² Pecoits-Filho, Roberto, et al. CONCORDIA study: interim analysis of all-cause mortality in patients treated with expanded haemodialysis versus a DOPPS external comparator [abstract 167]. Presented at: 63rd Congress of the European Renal Association; June 3–6, 2026; Glasgow, UK.

³ Kirsch AH, Lyko R, Nilsson LG, Beck W, Amdahl M, Lechner P, Schneider A, Wanner C, Rosenkranz AR, Krieter DH. Performance of hemodialysis with novel medium cut-off dialyzers. Nephrol Dial Transplant. 2017 Jan 1;32(1):165-172. doi: 10.1093/ndt/gfw310. Erratum in: Nephrol Dial Transplant. 2021 Jul 23;36(8):1555-1556. doi: 10.1093/ndt/gfaa322.

⁴ Weiner DE, Falzon L, Skoufos L, et al. Efficacy and safety of expanded hemodialysis with the Theranova 400 dialyzer: A randomized controlled trial. Clin J Am Soc Nephrol. 2020;15(9):1310-1319. doi:10.2215/CJN.01210120. PMID: 32843372; PMCID: PMC7480550. 

⁵ Garcia-Prieto, CKJ, 2018. Evaluation of the efficacy of a medium cut-off dialyser and comparison with other high-flux dialyzsers in conventional hemodialysis and online hemodiafiltration.

⁶ Kandi M, Brignardello-Petersen R, Couban R, Wu C, Nesrallah G. Clinical outcomes with medium cut-off versus high-flux hemodialysis membranes: A systematic review and meta-analysis. Can J Kidney Health Dis. 2022;9:20543581211067087. doi:10.1177/20543581211067087. PMID: 35083060; PMCID: PMC8785433. 

⁷ Penny J, Salerno F, Lemoine S, McIntyre CW. Impact of expanded dialysis using medium cut-off dialyzer on quality of life: Application of dynamic patient-reported outcome measurement tool. Kidney Med. 2021;3(6):100-107. doi:10.1016/j.xkme.2021.05.010. 

⁸ Alarcon JC, Bunch A, Ardila F, et al; Colombian Registry of Expanded Hemodialysis Investigators. Impact of medium cut-off dialyzers on patient-reported outcomes: COREXH Registry. Blood Purif. 2021;50(1):110-118. 

⁹ Bolton S, Gair R, Nilsson LG, Matthews M, Stewart L, McCullagh N. Clinical assessment of dialysis recovery time and symptom burden: Impact of switching hemodialysis therapy mode. Patient Relat Outcome Meas. 2021;12:315-321.

¹⁰ Lim JH, Seo YJ, Jeon Y, et al. Expanded hemodialysis with Theranova dialyzer and residual kidney function in patients starting long-term hemodialysis: A randomized controlled trial. J Am Soc Nephrol. 2025;36(8):1614-1625. doi:10.1681/ASN.0000000655. PMID: 40036081; PMCID: PMC12342098. 

¹¹ Blackowicz MJ, Falzon L, Beck W, Tran H, Weiner DE. Economic evaluation of expanded hemodialysis with the Theranova 400 dialyzer: A post hoc evaluation of a randomized clinical trial in the United States. Hemodial Int. 2022;26(3):449-455. doi:10.1111/hdi.13015. PMID: 35441486; PMCID: PMC9544662. 

¹² Vantive. Vantive highlights late-breaking high clinical impact data at ERA indicating HDx therapy is a practical alternative to online hemodiafiltration. Published June 8, 2026. https://www.vantive.com/news/press-releases/vantive-highlights-high-clinical-impact-data-indicating-hdx-practical-alternative 

SOURCE U.S. Renal Care