Clinical evidence on haemodiafiltration

Abstract

Haemodiafiltration (HDF) combines diffusive and convective solute removal in a single treatment session. HDF provides a greater removal of higher molecular weight uraemic retention solutes than conventional high-flux haemodialysis (HD). Recently completed randomized clinical trials suggest better patient survival with online HDF. The treatment is mainly used in Europe and Japan. This review gives a brief overview of the presently available evidence of the effects of HDF on clinical end points, it speculates on possible mechanisms of a beneficial effect of HDF as compared with standard HD and ends with some perspectives for the future.

Comparison of the effects of hemodialysis and hemodiafiltration on left ventricular hypertrophy in end‐stage renal disease patients: A systematic review and meta‐analysis

“…However, also at lower levels of convection volume, HDF has a better control of blood pressure over time, improves intradialytic hemodynamic stability, reduces markers of inflammation, and leads to a better removal rate of β2-microglobulin. 9,20 Nevertheless, the present study shows that LVH may improve in ESRD patients receiving chronic HD and the pooled mean difference between pre-and post-procedural LVMi was −8.0 g/m 2 . This is possibly secondary to the prevention and control of anemia, control of volume overload, use of antihypertensive drugs, prevention and treatment of hyperphosphatemia, and administration of vitamin D. 21 Our study has the usual limitations of meta-analysis of observational studies.…”

“…A recent individual participant data analysis on the results of the four large randomized controlled trials comparing HD and HDF demonstrated that the risk of all‐cause and cardiovascular mortality was significantly lower in the HDF group. However, a post‐hoc analysis stratifying patients by achieved convection volume showed that a minimum volume of 23L/session was required for HDF to achieve such benefit …”

“…However, also at lower levels of convection volume, HDF has a better control of blood pressure over time, improves intradialytic hemodynamic stability, reduces markers of inflammation, and leads to a better removal rate of β2‐microglobulin …”

“…Hemodiafiltration (HDF) combines diffusive and convective clearance of uremic solutes and is associated with better removal of both small‐ and medium‐sized molecules . HDF also improves intradialytic hemodynamic stability, reduces markers of inflammation, and determines a better control of blood pressure over time . These may be beneficial to the morphology and, consequently, function of the heart.…”

“…9 HDF also improves intradialytic hemodynamic stability, reduces markers of inflammation, and determines a better control of blood pressure over time. 9 These DOI: 10.1111/sdi.12864…”