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.