Expanding Possibility in Kidney Care: New Study Reinforces Multiple Pathways to Better Outcomes

Background contains a bubble-like molecular structures against a light blue background. Text reads "Treatment Innovation: MOTheR Trial Results

New data from the MOTheR trial1, one of the most rigorous head-to-head studies of advanced dialysis therapies to date, marks an important step forward in how the kidney care community approaches treatment for patients with end stage kidney disease.

Presented at the European Renal Association (ERA) Congress in June 2026, the prospective randomized controlled trial compared online hemodiafiltration (HDF) and expanded hemodialysis (expanded HD), two therapies designed to remove middle molecules, larger toxins linked to inflammation, cardiovascular complications and diminished quality of life.

Key Results: A New Benchmark in Kidney Care

The MOTheR trial met its primary endpoint, demonstrating that expanded HD using medium cut-off dialyzers is non-inferior to HDF on a composite outcome that includes both survival and major cardiovascular events.

The study evaluated a combined outcome of all-cause mortality and major cardiovascular events between the two modalities and established that there is more than one clinically validated pathway to advanced dialysis care. Ultimately, these findings support expanded HD as an effective, clinically sound approach to address middle-molecule clearance alongside HDF.

These results were supported by a retrospective analysis from the Dialysis Outcomes Practice Pattern Study (DOPPS) called CONCORDIA2, also presented at the ERA Congress. This study evaluated nearly 2,000 patients in real-world settings and found expanded HD to be non-inferior to HDF for all-cause mortality.

Taken together, the evidence supports that patients and physicians are not limited to a single approach to achieve more advanced toxin clearance.

Why This Matters: Advancing Middle-Molecule Clearance

Conventional high-flux dialyzers effectively remove small solutes and can clear some larger middle molecules, but they do so less efficiently, which may be associated with inflammation, cardiovascular risk and poorer patient-reported outcomes.

The MOTheR findings represent an important step forward in addressing this gap and advancing adoption of therapies that target middle-molecule clearance.

  • Clinical Impact: Both expanded HD and HDF are associated with improved middle-molecule removal and have the potential to enhance outcomes and quality of life for patients on dialysis, reinforcing multiple clinically valid pathways to better care.
  • Accessibility: Expanded HD can be deployed on existing dialysis machines using an advanced dialyzer, potentially enabling faster adoption than HDF, which requires new equipment — introducing greater flexibility for providers in how advanced therapies are implemented and scaled.
  • Enabling Physician Choice: With both therapies shown to effectively deliver middle-molecule clearance, physicians have greater flexibility to tailor treatment to individual patient needs, enabling more individualized decisions and supporting continuity of care across modalities.

Taken together, these dynamics help reduce traditional tradeoffs between access, cost and clinical performance, supporting a more adaptable, patient-centered approach to care delivery.

Inside the Clinical Outcomes: MOTheR Trial by the Numbers

  • 552 patients enrolled and randomized
    • 270 assigned to expanded HD
    • 282 assigned to HDF
  • Follow-up time frames of up to 36 months
  • Expanded HD demonstrated non-inferiority in its primary composite endpoint, which included all-cause mortality and major cardiac events like strokes.
    • The incidence rates of the composite endpoint were comparable between expanded HD (14.6 [11.6–18.4] events per 100 person-years) and HDF (16.9 [13.6–21.0] events per 100 person-years), with an incidence rate ratio (IRR) of 0.87 (95% confidence interval: 0.63–1.19).

Looking Ahead: Turning Evidence into Action

The MOTheR trial moves the field closer to a more precise, patient-centered era of dialysis care, where therapy decisions are driven by what best supports outcomes and patient experience rather than by practical limitations.

As the evidence base continues to grow, the findings reinforce the importance of maintaining multiple validated treatment pathways to support diverse patient needs. They also highlight the opportunity to further evaluate how these approaches perform across different care settings and patient populations in real-world practice.

By continuing to build on this foundation, the kidney care community can advance more flexible, scalable and individualized models of care — ensuring that more patients benefit from therapies designed to improve outcomes and quality of life.

[1] 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.

[2] 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.