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. 2025 Feb 11;15:5039. doi: 10.1038/s41598-025-88827-2

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© The Author(s) 2025

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

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Fig. 8 — Working-hypothesis: Schematic diagram of the metabolic pathways altered by a shift from S-HD to E-HD. Relatively enhanced metabolic pathways, i.e., glycolysis, and fatty acid metabolism in S-HD, are suppressed in E-HD, while relatively suppressed citric acid cycle in S-HD, is ameliorated in E-HD (a). Glutathion synsethis is facilitated in E-HD as compared to S-HD (b). S-HD: standard hemodialysis, E-HD: electrolyzed water hemodialysis.