Short-term efficacy and safety of hemodialysis using super high-flux dialyzers compared with online hemodiafiltration: a cross-sectional study in Vietnam

Background: Online hemodiafiltration (OL-HDF) enhances removal of middle-molecule uremic toxins but requires ultrapure water systems and specialized equipment, limiting uptake in many low- and middle-income countries. Super high-flux (SHF) dialyzers have been proposed as a pragmatic alternative to improve permeability and remove larger solutes using standard hemodialysis machines, yet no evaluation has been conducted in Vietnam. Our study aimed to compare the short-term efficacy and safety of HD using SHF dialyzers (SHF-HD) with post-dilution OL-HDF in a real-world Vietnamese tertiary center. Methods: This cross-sectional study enrolled 30 patients receiving maintenance dialysis at People’s Hospital 115 (Ho Chi Minh City, Vietnam). Among those, fifteen patients received SHF-HD and fifteen received OL-HDF. A single 240-minute session was examined per patient. Blood samples were drawn pre- and post-dialysis to measure urea, β₂-microglobulin, parathyroid hormone, interleukin-6, leptin, albumin, and C-reactive protein concentration. Reduction ratios for middle molecules were hematocrit-corrected. Results: Baseline demographics, comorbidities, and biochemical parameters were comparable between groups. Both pre- and post-dialysis concentrations of solutes showed no significant differences between modalities. Reduction ratios of middle-molecule toxins showed no significant differences between SHF-HD and OL-HDF, including β₂-microglobulin (65.05% vs. 68.20%, p  = 0.561), parathyroid hormone (66.32% vs. 63.57%, p  = 0.803), interleukin-6 (23.62% vs. 21.20%, p  = 0.213), and leptin (41.08% vs. 36.36%, p  = 0.678). Albumin changes were minimal in both groups (− 0.40 ± 0.68 vs. −0.44 ± 1.32 g/L, p  = 0.911), and C-reactive protein remained stable. Across all 30 treatment sessions, no intradialytic complications were observed. Conclusions: In this first Vietnamese evaluation, SHF-HD provided short-term removal of middle-molecule solutes comparable to OL-HDF, with minimal albumin loss, stable inflammatory markers, and no adverse events. Larger longitudinal studies are warranted to determine whether the observed biochemical equivalence translates into long-term clinical benefits.