EBOO is not a form of dialysis, and it is not plasmapheresis. Dialysis removes waste solutes and excess fluid from blood. Plasma exchange removes plasma and replaces it with albumin or donor plasma. EBOO adds ozone and oxygen to blood across a membrane and returns the same blood to you — there is no dialysate carrying solutes away and no plasma is discarded or replaced. “EBO2” is a commercial product name used by device vendors and clinics, not a separate procedure defined anywhere in the medical literature.
These distinctions matter more than they sound. Patients regularly arrive at our Beverly Hills clinic believing EBOO will do for them what a nephrologist’s machine does for someone in kidney failure, or what an apheresis unit does for someone with an autoimmune crisis. It will not, and a clinic that lets you believe otherwise is setting you up for disappointment at best.
The four procedures at a glance
| Hemodialysis | Plasma exchange (TPE) | EBOO | |
|---|---|---|---|
| What leaves the body | Urea, creatinine, potassium, phosphate, excess fluid | Whole plasma, with the antibodies and proteins in it | Nothing is carried away in a dialysate or discarded |
| What is added | Bicarbonate, calcium, sodium from the dialysate | Replacement fluid: 5% albumin or donor plasma | Ozone and oxygen, diffused across a membrane |
| Mechanism | Diffusion down a concentration gradient, plus ultrafiltration | Bulk separation and removal of plasma | Gas exchange across a hollow-fibre membrane |
| Typical schedule | 3 sessions a week, 3–4 hours each, indefinitely | 5–7 procedures over 7–14 days | 1–3 sessions; the original protocol used 14 over 7 weeks |
| Why it is done | Kidney failure. It is life-sustaining. | Specific antibody-mediated diseases, under graded guidelines | Elective wellness. No recognised medical indication. |
| Evidence base | Decades of trials; standard of care | Graded indication categories published by a specialty society | One small randomised trial from 2005, never replicated |
What hemodialysis actually does
In hemodialysis, blood is pumped along one side of a semipermeable membrane while a fluid called dialysate flows along the other. Small waste solutes that have built up because the kidneys can no longer clear them — urea, creatinine, potassium, phosphate — move down their concentration gradient out of the blood and into the dialysate, which carries them away. Bicarbonate, calcium and sodium move the other way, correcting the blood chemistry. A separate pressure gradient, ultrafiltration, pulls off excess fluid.
Maintenance dialysis usually means three sessions a week, three to four hours each, at blood flow rates above 300 mL per minute, through surgically created vascular access. It continues for life or until transplant. It is done because without it the patient dies. That is the frame to hold in mind for everything that follows.
What plasma exchange actually does
Therapeutic plasma exchange separates plasma from the cellular part of blood and discards it, taking with it whatever pathogenic material was dissolved in it — autoantibodies, immune complexes, paraproteins. Because you cannot simply remove a litre of someone’s plasma and give nothing back, the discarded volume is replaced, usually with 5% albumin, or with donor plasma when clotting factors also need replacing.
A session typically exchanges one to one-and-a-half estimated plasma volumes over one to three hours, and a course is usually five to seven procedures over one to two weeks. Which conditions warrant it is not left to individual judgment: the American Society for Apheresis publishes graded, evidence-based indication categories in the Journal of Clinical Apheresis, where Category I means apheresis is accepted first-line therapy. Thrombotic thrombocytopenic purpura, Guillain-Barré syndrome and moderate-to-severe myasthenia gravis sit in that category, each with its own qualifying detail.
That is what a procedure with an established role looks like: a named specialty society, a published grading system, and defined sub-indications.
What EBOO actually does — and what the literature actually contains
EBOO stands for extracorporeal blood oxygenation and ozonation. Blood is drawn from a vein, pumped through a cartridge of ozone-resistant hollow fibres while an oxygen-ozone mixture flows on the other side of the membrane, and returned to the other arm. The gas diffuses into the blood. Our full guide to how EBOO + UV Light works covers the three stages in detail.
The honest summary of the evidence is short. The technique was developed at the University of Siena and described by Di Paolo and colleagues in Redox Report in 2005, reporting more than 1,200 treatments in 82 patients and the ability to treat up to 4,800 mL of heparinised blood in an hour — against roughly 250 mL by classical autohemotherapy. The standard cycle in that work was fourteen one-hour sessions over seven weeks. A companion controlled trial in the International Journal of Artificial Organs the same year randomised 28 patients with peripheral artery disease to EBOO or intravenous prostacyclin and reported improvement in skin lesions, pain and wellbeing — while noting no apparent change in arterial circulation.
Twenty years later, that trial has not been replicated. There is no systematic review, no specialty-society guideline, no graded indication list. The measurable biological effect the original authors documented was a four- to five-fold rise in a marker of lipid peroxidation with a corresponding fall in plasma protein thiols — in other words, a deliberate oxidative challenge, which is the intended mechanism rather than a side finding.
So EBOO is best understood as an elective wellness procedure with an interesting mechanism and a thin evidence base. It is not a treatment for kidney failure, and it is not an alternative to apheresis for antibody-mediated disease. If you have a condition for which dialysis or plasma exchange is indicated, EBOO does not substitute for either, and no responsible clinic will offer it as one.
EBOO has a literature. EBO2 has a name.Then what is EBO2?
“EBO2” appears nowhere in the scientific literature. Searching the indexed medical databases for it returns EBOO papers and unrelated ozone studies — there is no publication, no clinical trial and no trial registration studying EBO2 as an intervention distinct from EBOO.
What EBO2 is, in practice, is a product and protocol name used by device vendors and by the clinics that buy from them. The most consistent claimed difference is the addition of a light step, applying several wavelengths to the blood in the circuit. Beyond that, the descriptions do not agree with each other: published clinic pages variously state four, five to eight, or six to eight litres processed, over forty-five, sixty or ninety minutes, with different wavelength lists.
You will also find pages arguing that EBO2 is a “new gold standard” and superior to EBOO. There is no published head-to-head comparison of the two, no trial of the added light step in this context, and no outcome data attributable to it. Adding ultraviolet exposure to blood is a further intervention with its own unevaluated profile, not a self-evidently better version of the same thing. When a comparison rests entirely on the assertion of the people selling the device, that is worth knowing before you pay for it.
If you want an evidence-grounded comparison of the ozone options that genuinely differ from one another, our breakdown of EBOO vs 10-pass ozone vs UBI compares blood volume, session length and intensity across the three, and the UBI page explains what the ultraviolet component does on its own.
The risks are the circuit, not the ozone
Every one of these procedures runs your blood outside your body through tubing and a pump, and that shared design carries shared risks: venous air embolism, haemolysis, effects of the anticoagulation required to keep the circuit from clotting, and line-associated infection. Those risks are real in dialysis units and apheresis suites too.
The difference is the trade. In dialysis and plasma exchange those risks are accepted because the alternative is organ failure or death, the procedures run in accredited facilities under specialist supervision, and adverse events are systematically reported. For an elective wellness procedure, the same circuit risks buy you a much smaller and much less certain benefit. That asymmetry is the single most useful thing to understand before booking, and it is why screening matters — our article on EBOO side effects and who should avoid it covers the specific contraindications, G6PD status first among them.
Frequently asked questions
Is EBOO the same as dialysis?
No. Both run blood through an external circuit and both use a cartridge of hollow fibres, which is where the visual resemblance comes from. But dialysis uses a dialysate fluid to carry waste solutes out of the blood and remove excess fluid, and it exists to replace failed kidney function. EBOO adds ozone and oxygen to the blood across the membrane and returns the same blood. It has no dialysate and no equivalent clinical indication.
Is EBOO a kind of plasmapheresis?
No. Plasma exchange removes plasma and replaces it with albumin or donor plasma. Nothing comparable happens in EBOO — no plasma is discarded and no replacement fluid is given.
What is the difference between EBO2 and EBOO?
EBOO is the procedure described in the medical literature. EBO2 is a commercial product name, generally describing EBOO with a light step added. There is no published study of EBO2 as a distinct intervention and no head-to-head comparison with EBOO, so claims that one is superior rest on vendor assertion rather than data.
Can EBOO replace my dialysis sessions?
Absolutely not, and nobody should suggest otherwise. Dialysis is life-sustaining treatment for kidney failure. If you are on dialysis, any decision about additional procedures belongs with your nephrologist.
Does EBOO filter toxins out of the blood?
The mechanism described in the original literature is gas exchange — ozone and oxygen moving into the blood — not extraction. Claims that the procedure removes heavy metals, cholesterol, inflammatory proteins or senescent cells go beyond what the published mechanism supports, and we do not make them.
Which one does my condition actually call for?
If you have a diagnosed kidney or antibody-mediated condition, that question belongs to the nephrologist or apheresis service managing it, and the answer will come from established indication criteria rather than from a wellness clinic.
Important medical disclaimer
These statements have not been evaluated by the Food and Drug Administration. EBOO is not FDA-approved, is not intended to diagnose, treat, cure or prevent any disease, and is not a substitute for hemodialysis, therapeutic plasma exchange or any other medically indicated procedure. This article is educational and is not medical advice. Decisions about dialysis or apheresis should be made with the specialist managing your care. Ozone therapy is provided only after medical consultation, and candidacy is determined individually.
Sources referenced
Di Paolo N, Gaggiotti E, Galli F. “Extracorporeal blood oxygenation and ozonation: clinical and biological implications of ozone therapy.” Redox Report, 2005;10(3):121–130. · Di Paolo N, Bocci V, Salvo DP, et al. “Extracorporeal blood oxygenation and ozonation (EBOO): a controlled trial in patients with peripheral artery disease.” International Journal of Artificial Organs, 2005;28(10):1039–1050. · Bocci V, Zanardi I, Travagli V, Di Paolo N. “Oxygenation-ozonation of blood during extracorporeal circulation: in vitro efficiency of a new gas exchange device.” Artificial Organs, 2007;31(9):743–748. · “Therapeutic Plasma Exchange: Core Curriculum 2023.” American Journal of Kidney Diseases, 2023. · “Hemodialysis Emergencies: Core Curriculum 2021.” American Journal of Kidney Diseases, 2021. · Connelly-Smith L, Alquist CR, Aqui NA, et al. “Guidelines on the Use of Therapeutic Apheresis in Clinical Practice.” Journal of Clinical Apheresis, 2023;38(2):77–278.
Medically reviewed by Biana Borchenko, FNP-BC (A4M) — Robertson Wellness & Aesthetics, Beverly Hills.
