Creating Broad Access to Advanced Care
Our goal is to ensure that every physician and appropriate patient who wants advanced middle molecule clearance gains access to it in the upcoming months. That’s why we’re bringing expanded hemodialysis (HD) to all of our U.S. centers as the immediately scalable, research-backed pathway to enhanced care.
Improved Clinical Outcomes
International evidence links enhanced middle molecule clearance to improved patient outcomes.1,2,3
Enhanced Quality of Life
Patients report improvements in areas like sleep, post-treatment recovery, cognitive function and itching or restless legs. 4, 5, 6
Multiple Promising Pathways
Both Expanded HD and HDF have been shown in multiple studies to be safe and effective treatments for ESKD. 1, 7, 8, 9
Large Molecular Size
Why Improved Clearance Matters
Middle molecules have been correlated with increased inflammation, cardiovascular disease, and other complications for patients with kidney failure. 10, 11
In the 2000s, high-flux dialyzers provided a significant advancement in patient care, excelling in removing smaller waste products like urea, creatinine and other small solutes.
Today, we are taking another step forward in patient care with new treatment options that are significantly better at removing the middle molecule toxins that high-flux leaves behind. 12
Learn about our clinical approach.
Pursuing Multiple Pathways to Better Outcomes
Expanded Hemodialysis (Expanded HD)
Expanded HD employs the same basic equipment, software and workflows as conventional hemodialysis, requiring only a straightforward dialyzer upgrade to achieve enhanced middle molecule clearance. It can be quickly adopted in virtually any center today, and is appropriate for the vast majority of U.S. maintenance hemodialysis patients.
This ease of implementation, combined with research-backed efficacy that is clinically comparable to other well studied treatments 2,3,8,9 makes Expanded HD the most promising pathway for immediate adoption.
Learn more about Expanded HD
High-Volume Hemodiafiltration (HDF)
High-Volume Hemodiafiltration is an emerging US therapy with new and unique requirements in equipment and workflows. This approach uses specialized machines and removes a large volume of fluid during treatment (often >23 liters) to clear larger toxins from the blood. Like Expanded HD, HDF has been shown to provide effective clearance of middle molecules. 4
We are continuing to evaluate HDF as a promising treatment for those patients for whom it is clinically appropriate.
Learn more about HDF
New Initiatives Explore Middle Molecule Clearance
MOTheR Results Support Expanded Dialysis Options
New data proves expanded hemodialysis effectively improves middle molecule clearance
MODEL and MEMOIRS: Evaluating Middle Molecule Clearance
These two initiatives evaluate how advanced dialysis treatments impact survival and quality of life.
A Difference Patients and Providers Can Feel
Hear from DaVita patients and care team members about the impact of Expanded HD on the treatment experience, post-recovery, and overall quality of life.
Latest Industry News on Dialysis Care
Explore the Conversation
As therapies emerge in the U.S. to address middle-molecule clearance, stay informed on how DaVita is unlocking next-generation dialysis to provide physicians tools and evidence for improved patient outcomes.
DaVita Expands Access to Enhanced Kidney Care
DaVita is bringing Expanded HD to more patients across the U.S. using newly FDA-cleared NIPRO’s ELISIO-HX dialyzers to expand access to enhanced middle molecule clearance….see the LinkedIn post
Expanded HD: Patient Experiences
As DaVita expands access to Expanded HD, patients recently starting the therapy are sharing positive experiences, including changes in their energy, confidence, and quality of life….see the LinkedIn post
Middle Molecule Clearance: Our Path Forward
Dig deeper into why middle molecules matter, the science behind them, and how we’re stepping forward to lead with Expanded HD.
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[1] Blankestijn PJ, Vernooij RWM, Hockham C, et al. Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure. N Engl J Med. 2023;389(8):700-709. doi:10.1056/NEJMoa2304820
[2] Abe, M., Masakane, I., Wada, A. et al. High-performance dialyzers and mortality in maintenance hemodialysis patients. Sci Rep 11, 12272 (2021). https://doi.org/10.1038/s41598-021-91751-w
[3] Castillo JC, Vesga J, Rivera A, et al. Survival Differences in Patients with High-Flux Hemodialysis versus Expanded Hemodialysis: A Cohort Study. Blood Purif. 2025;54(12):772-781. doi:10.1159/000548158
[4] Rose M, Fischer FH, Liegl G, et al. The CONVINCE randomized trial found positive effects on quality of life for patients with chronic kidney disease treated with hemodiafiltration. Kidney Int. 2024;106(5):961-971. doi:10.1016/j.kint.2024.07.014
[5] Lim, JH., Park, Y., Yook, JM. et al. Randomized controlled trial of medium cut-off versus high-flux dialyzers on quality of life outcomes in maintenance hemodialysis patients. Sci Rep 10, 7780 (2020). https://doi.org/10.1038/s41598-020-64622-z
[6] Penny JD, Gozdzik D, Tamasi T, et al. Impact of Expanded Hemodialysis on Subjective Experience Using Dynamic Patient-Reported Outcome Measurement Tool. Kidney Med. 2025;7(12):101134. Published 2025 Oct 10. doi:10.1016/j.xkme.2025.101134
[7] Castillo JC, Doria C, Cely J, et al. Efficacy in the reduction ratios of middle molecules with the use of medium cut-off dialyzers and reduced dialysate flows: a cohort study. Front Med (Lausanne). 2025;12:1663750. Published 2025 Oct 9. doi:10.3389/fmed.2025.1663750
[8] De Sequera Ortiz P, Pérez García R, Martínez-Vaquera S, et al. MOTheR HDx Study: A MOPR Study to Explore Morbidity and Mortality in Patients Dialyzed with Theranova HDx Compared with OL-HDF. Abstract presented at: ERA Congress; 2026.
[9] Pecoits-Filho R, Ferraro PM, et al. The CONCORDIA Study: All-Cause Mortality with HDx with Theranova Compared with Hemodiafiltration Using DOPPS as an External Real-World Comparator. Abstract presented at: ERA Congress; 2026.
[10]Wolley MJ, Hutchison CA. Large Uremic Toxins: An Unsolved Problem in End-Stage Kidney Disease. Nephrology, Dialysis, Transplantation. 2018;33(suppl_3):iii6-iii11.
[11]Fatigue in Patients Receiving Maintenance Hemodialysis: A Review. Bossola, Maurizio et al. American Journal of Kidney Diseases, Volume 82, Issue 4, 464 – 480
[12]Maduell et al., 2023; Kirsch et al., 2017; Belmouaz et al., 2020; Cho et al., 2019; Kim et al., 2019.