Real-world effectiveness of central dialysis fluid delivery system (CDDS) in maintenance hemodialysis: a retrospective multicenter study.
CDDS use was associated with improved nutritional and hematologic indicators in maintenance hemodialysis patients, but no significant differences were found in inflammatory markers or dialysis adequacy.
Where it sits
this study against the rest of the erythropoietin (epo) corpusSummary and findings
This study compared the effectiveness of a central dialysis fluid delivery system (CDDS) with single-patient dialysis delivery systems (SPDDS) in maintenance hemodialysis patients. A total of 368 patients were analyzed, with 253 in the CDDS group and 115 in the SPDDS group. The CDDS was associated with higher levels of total protein, albumin, and hemoglobin after adjustment.
Abstract
This study aimed to compare the real-world effectiveness of a central dialysis fluid delivery system (CDDS) with single-patient dialysis delivery systems (SPDDS) in patients undergoing maintenance hemodialysis (MHD), focusing on inflammation markers, nutritional status, and dialysis adequacy. We conducted a retrospective cohort analysis of 368 MHD patients from three hemodialysis centers in Shanghai, China, between January 2020 and June 2023 was analyzed (CDDS, n = 253; SPDDS, n = 115). Generalized linear mixed-effects models were used to evaluate longitudinal associations between dialysate delivery systems and clinical outcomes. Subgroup analyses were performed to examine effect modification by age, diabetes status, baseline inflammation, and dialysis modality. Compared with SPDDS, CDDS was associated with higher levels of total protein (β = 0.91 g/L), albumin (β = 1.71 g/L), and hemoglobin (β = 3.50 g/L) after multivariable adjustment (all p < 0.05), while no statistically significant differences were observed in creatinine or urea reduction after adjustment. Subgroup analysis indicated that CDDS was particularly effective in improving albumin levels among patients aged < 70 years, those with diabetes, or those with elevated CRP levels. In patients aged ≥ 70, CDDS was associated with better anemia control and enhanced dialysis adequacy. Nutritional benefits were consistently observed in patients receiving a regimen of twice-weekly high-flux hemodialysis combined with once-weekly hemodiafiltration. In conclusion, CDDS use was associated with improved nutritional and hematologic indicators in this real-world cohort, while differences in inflammatory markers and dialysis adequacy were not statistically significant after multivariable adjustment.