By combining diffusive and enhanced convective clearances, hemodiafiltration (HDF) offers the most efficient and biocompatible renal replacement therapy modality at the present time. HDF increases solute mass transfer and enlarges the molecular weight spectrum of uremic toxins, and reduces the microinflammation profile of dialysis patients. Online (ol) production of substitution fluid by 'cold sterilization' of dialysis fluid gives access to virtually an unlimited amount of sterile and non-pyrogenic solution. ol-HDF provides a multipurpose platform that permits to develop and customize HDF options (HDF, post-, pre-, mixed-, mid-dilution) to patients' needs. With these unique features, ol-HDF should be considered as a dialysis platform permitting to develop new options such as feedback-controlled volemia, automation of priming and restitution and daily treatment schedule. At the present time, ol-HDF offers major options to enhance dialysis efficacy and to improve global care of patients.

Conventional diffusive-based dialysis modalities including high-flux hemodialysis are limited in their capacity to clear middle and large size uremic toxins. Middle molecule substances are recognized as pathogenic substances implicated in the genesis of accelerated atherosclerosis. Convective methods, mimicking glomeruli filtration of native kidneys, are required to enlarge the molecular weight spectrum of solutes removed. By combining diffusive and convective solute clearances, HDF offers at the present time the highest dialysis efficiency method with the more biocompatible profile. Instantaneous dialyzer clearance does not reflect solute mass removal when body clearance is concerned. Intracorporeal resistance to solute clearance is the main barrier to solute removal. Increasing treatment time and/or frequency of sessions in hemodiafiltration is the only way to overcome body barriers generated from patient/dialysis interaction. A dialysis dose based on normalized middle molecules clearance using Beta2-microglobulin as surrogate marker should be considered as a new adequacy target.

Good medical practices for optimizing the management of central venous catheters (CVCs) can be summarized in the following ten commandments: (1) the indications of CVC use you will restrict; (2) the choice of the catheter type and site venous you will discuss; (3) an experienced operator you will choose; (4) validated protocols of use and maintenance of catheters you will respect; (5) caring and nursing staff of the dialysis unit you will train and control; (6) the patients you will educate; (7) monitoring and maintenance care of CVC you will apply; (8) the duration of CVC use you will restrict; (9) specific patient risk factors you will evaluate and correct, and (10) a continuous quality improvement care process for CVC you will establish and apply in your dialysis unit.

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