Abstract
In end-stage kidney disease patients, hemodiafiltration, a mixed diffusive-convective technique, has shown beneficial effects in terms of improvement of anemia, inflammation, mineral bone disorders, malnutrition and cardiovascular stability. Greater convective volume exchange was also associated with improved overall and cardiovascular survival. However, absolute target threshold volume would be difficult to define and achieve in daily clinical practice, mainly because of differences in patient size. Convective volumes standardized for body surface area would appear to be the simplest approach in clinical practice. Several factors can affect achievement of optimal convective volume, with vascular access being the main limiting factor. Based on our own clinical experience, hemodiafiltration is a more effective and preferable dialysis technique but only when a target convective volume greater than 20 L can be achieved. Conversely, standard high flux hemodialysis or expanded hemodialysis may be helpful and valuable alternative dialysis techniques.
References
Leber H, Wizemann V, Goubeaud G, Rawer P, Schutterle G (1978) Hemodiafiltration: a new alternative to hemofiltration and conventional hemodialysis. Artif Organs 2:150–153
Canaud B, Kohler K, Sichart JM, Moller S (2019) Global prevalent use, trends and practices in haemodiafiltration. Nephrol Dial Transplant 35(3):398–407
Panichi V, Rizza GM, Paoletti S, RISCAVID Study Group et al (2008) Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Results from the RISCAVID study. Nephrol Dial Transplant 23:2337–2343
Vilar E, Fry AC, Wellsted D, Tattersall JE, Greenwood RN, Farrington K (2009) Long-term outcomes in online hemodiafiltration and high-flux hemodialysis: a comparative analysis. Clin J Am Soc Nephrol 4:1944–1953
Locatelli F, Carfagna F, Del Vecchio L, La Milia V (2018) Haemodialysis or haemodiafiltration: that is the question. Nephrol Dial Transplant 33(11):1896–1904
BlankestijnP J, Grooteman MP, Nube MJ, Bots ML (2018) Clinical evidence on haemodiafiltration. Nephrol Dial Transplant 33:iii53–iii58
Panichi V, Scatena A, Rosati A, Giusti R, Ferro G, Malagnino E, Capitanini A, Piluso A, Conti P, Bernabini G, Migliori M, Caiani D, Tetta C, Casani A, Betti G, Pizzarelli F (2015) High-volume online haemodiafiltration improves erythropoiesis stimulating agent (ESA) resistance in comparison with low-flux bicarbonate dialysis: results of the REDERT study. Nephrol Dial Transplant 30:682–689
Grooteman MP, van den Dorpel MA, Bots ML, for the CONTRAST Investigators et al (2012) Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol 23:1087–1096
Ok E, Asci G, Toz H et al (2013) Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the TURKISH OL-HDF study. Nephrol Dial Transplant 28:192–202
Maduell F, Moreso F, Pons M et al (2013) ESHOL study group: high-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 24:487–497
Morena M, Jaussent A, Chalabi L et al (2017) FRENCHIE Study Investigators: treatment tolerance and patientreported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly. Kidney Int 91:1495–1509
Blankestijn PJ, Vernooij RWM, Hockham C, Strippoli GFM, Canaud B, Hegbrant J, Barth C, Covic A, Cromm K, Cucui A, Davenport A, Rose M, Török M, Woodward M, Bots ML, CONVINCE Scientific Committee Investigators (2023) Effect of hemodiafiltration or hemodialysis on mortality in kidney failure. N Engl J Med. https://doi.org/10.1056/NEJMoa2304820
Caskey FJ, Procter S, MacNeill SJ, Wade J, Taylor J, Rooshenas L, Liu Y, Annaw A, Alloway K, Davenport A et al (2022) The high-volume haemodiafiltration vs high-flux haemodialysis registry trial (H4RT): a multi-centre, unblinded, randomised, parallel-group, superiority study to compare the effectiveness and cost-effectiveness of high-volume haemodiafiltration and high-flux haemodialysis in people with kidney failure on maintenance dialysis using linkage to routine healthcare databases for outcomes. Trials 23:532
Canaud B, Vienken J, Ash S, Ward RA, on behalf of the Kidney Health Initiative HDF Workgroup et al (2018) Hemodiafiltration to address unmet medical needs ESKD patients. CJASN March 2018
Peters SA, Bots ML, Canaud B, Davenport A, Grooteman MP, Kircelli F, Locatelli F, Maduell F, Morena M, Nube MJ, Ok E, Torres F, Woodward M, Blankestijn PJ, HDF Pooling Project Investigators (2016) Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials. Nephrol Dial Transplant 31:978–984
Davenport A, Peters SAE, Bots ML, Canaud B, Grooteman MPC, Asci G, Locatelli F, Maduell F, Morena M, Nube MJ, Ok E, Torres F, Woodward M, Blankestijn PJ, HDF Pooling Project Investigators (2016) Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: the effect of adjustment for body size. Kidney Int 89:193–199
Gehan EA, George SL (1970) Estimation of human body surface area from height and weight. Cancer Chemother Rep 54:225–235
Bowry SK, Canaud B (2013) Achieving high convective volumes in online hemodiafiltration. Blood Purif 35(Suppl 1):23–28
Chapdelaine I, van Zuijdewijn CLMR, Mostovaya IM, Lévesque R, Davenport A, Blankestijn PJ, Wanner C, Nubé MJ, Grooteman MPC, on behalf of the EUDIAL Group (2015) Optimization of the convection volume in online post-dilution haemodiafiltration: practical and technical issues. Clin Kidney J 8:191–198
Penne EL, van der Weerd NC, Bots ML, van den Dorpel MA, Grooteman MPC, Lévesque R, Nubé MJ, Ter Wee PM, Blankestijn PJ, CONTRAST investigators (2009) Patient- and treatment-related determinants of convective volume in postdilution haemodiafiltration in clinical practice. Nephrol Dial Transplant 24(11):3493–3499
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Mangione, E., Giannese, D., Cupisti, A. et al. ABCs of hemodiafiltration prescription: The Pisa style. J Nephrol 37, 331–335 (2024). https://doi.org/10.1007/s40620-023-01768-9
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DOI: https://doi.org/10.1007/s40620-023-01768-9