Expanded vs. Conventional Hemodialysis
In conventional hemodialysis, using high-flux hemodialysis filters removes small and smaller-sized molecule toxins, but does not effectively remove larger-sized middle molecules. These larger-sized middle molecules may contribute to fatigue, cardiovascular disease, increased infections, anemia, and other complications for patients who receive chronic maintenance hemodialysis.
A new class of filter – the medium cut-off (MCO) filter – is more permeable than conventional high-flux filters, which allows the passage of larger middle molecules, expanding the breadth of toxin removal. Small studies on the effect of MCO filter use show promising results in improving patient outcome, but were small, short and have risk of bias.
Dr. Pavel Roshanov proposed a pragmatic cluster randomized controlled trial testing the effects of MCO filters in hemodialysis to determine if its use on the primary outcome of hospitalizations and all-cause mortality, and secondary outcomes that include cardiovascular events, infection-related hospitalization, receipt of kidney transplantation, and healthcare-associated costs.
Dr. Pavel Roshanov
Pavel Roshanov is a staff nephrologist at the London Health Sciences Centre, Assistant Professor of Medicine, the Division of Nephrology, Professor of Epidemiology and Biostatistics at Western University, Scientist in the Lawson Health Research Institute in London, Ontario, and Investigator at the Population Health Research Institute in Hamilton, Ontario. He received his MD at Western University, his PhD in clinical Epidemiology and Biostatistics from McMasters University, and his BS in Health Studies from the University of Waterloo.
Dr. Roshanov’s clinical work and research interests concentrate on conducting clinical research in perioperative care and inflammation, with the goal of improving the care and outcomes of persons living with kidney disease. He has conducted large collaborative observational studies, randomized trials, and systematic reviews focused on addressing knowledge gaps in the care of patients with kidney disease and published more than 40 peer-reviewed articles discussing perioperative complications and medical informatics.
Dr. Gihad Nesrallah
Dr. Gihad Nesrallah is a practicing Nephrologist and values-based physician leader with expertise spanning health research methodology and healthcare business strategy. He completed his clinical training at Western University, a Master of Health Research Methodology at McMaster University, and an Executive MBA at the Kellogg School of Management at Northwestern University and leverages this joint expertise to build successful research and innovation ventures in kidney care and to solve complex health system problems.
His academic contributions include original clinical research, knowledge synthesis, and practice guidelines, as well as quality improvement and policy interventions across a range of topics including dialysis and chronic kidney disease outcomes, modality selection , vascular access, novel dialysis technologies, and digital health tools.