Clinical performance, intermediate and long‐term outcomes of high‐volume hemodiafiltration in patients with kidney failure

Abstract

Hemodiafiltration (HDF), in which both convective and diffusion methods are combined, yields an increased overall solute clearance compared with hemodialysis (HD), specifically for medium and larger molecular weight uremic toxins. Due to uncertainty in the treatment effects, the nephrology community still perceives the implementation of HDF and the achievement of high convective volume as complex.In this article, we review practical aspects of the implementation of HDF that can effectively deliver a high-volume HDF therapy and assure clinical performance to most patients. We also present an overview of the impact of high-volume HDF (compared to HD) on a series of relevant biochemical, patient-reported, and clinical outcomes, including uremic toxin removal, phosphate, Inflammation and oxidative stress, hemodynamic stability, cardiac outcomes, nutritional effects, health-related quality of life, morbidity, and mortality.

High volume online hemodiafiltration: a global perspective and the Brazilian experience

“…Larger gauge needles – 14G or 15G – are recommended to enable adequate convection volumes 16 , 18 , 22 , 23 . The dialysis solution formulations used in online HDF are the same as the ones used in conventional hemodialysis.…”

“…Recommendations stress a preference for using solutions with glucose, potassium > 2 mEq/L and bicarbonate 32 mEq/L. Calcium concentration, usually set at 2.5 or 3 mEq/L, must be individualized 1 , 16 , 22 , 24 .…”

“…Blood flow might be the single most important variable for achieving adequate convection volumes. There is a direct relationship between convection volume and effective blood flow 14 , 15 , 17 , 22 . To maintain an effective blood flow of at least 350 mL/min, good vascular access and monitoring arterial and venous pressure in the vascular access are required.…”

“…To maintain an effective blood flow of at least 350 mL/min, good vascular access and monitoring arterial and venous pressure in the vascular access are required. Larger gauge needles are recommended for patients with arteriovenous fistulas or grafts 16 , 17 , 22 , 23 , 30 . In patients with a central venous catheter, achieving high blood flows depends on the model and diameter of the lumen of the catheter 30 .…”

Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond

“…Short-term benefits are those related to intradialytic or interdialysis effects, such as improved hemodynamic stability, reduced post-treatment fatigue, better weight management, and blood pressure control. Prolonged exposure to this treatment leads to intermediate benefits, including improved nutritional status and phosphorus levels, reduced inflammation and oxidative stress, alleviation of neurological symptoms and joint pain, enhanced response to erythropoietin, and better immune response [ 9 ].…”