Online haemodiafiltration: definition, dose quantification and safety revisited

Abstract

The general objective assigned to the EUropean DIALlysis (EUDIAL) Working Group by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) was to enhance the quality of dialysis therapies in Europe in the broadest possible sense. Given the increasing interest in convective therapies, the Working Group has started by focusing on haemodiafiltration (HDF) therapies. Several reports suggest that those therapies potentially improve the outcomes for end-stage renal disease patients. Europe is the leader in the field, having introduced the concept of ultra-purity for water and dialysis fluids and with notified bodies of the European Community having certified water treatment systems and online HDF machines. The prevalence of online HDF-treated patients is steadily increasing in Europe, averaging 15%. A EUDIAL consensus conference was held in Paris on 13 October 2011 to revisit terminology, safety and efficacy of online HDF. This is the first report of the expert group arising from that conference.

Has the Time Now Come to More Widely Accept Hemodiafiltration in the United States?

“…Today, sterile substitution fluid is prepared online, thus enabling production of large volumes of substitution fluid at an acceptable cost in everyday clinical practice. 2 Increased interest in HDF was triggered by analysis of European Dialysis Outcomes and Practice Patterns Study (DOPPS) data. 3 This retrospective study suggests that use of HDF confers a survival benefit compared with HD.…”

“…This working group has produced one paper summarizing definitions, dose quantification, and safety; a second paper on clinical evidence will be released shortly. 2 Several important aspects of HDF have not been addressed so far. The above-mentioned randomized trials used the traditional schedule of three treatments per week, thus addressing the question of whether HDF can provide a better outcome in that logistic and organizational infrastructure.…”

“…Put another way, the same high-quality fluid levels defined for HDF should also be standard for high-flux HD. 2 Thus, conceptually, it seems incorrect to demand stricter quality levels for HDF than for high-flux HD.…”

“…Emerging evidence largely supports this view, with most, although not all studies, showing biochemical, cardiovascular, quality of life, or survival benefits with short daily or slow nocturnal hemodialysis. [1][2][3][4][5] Much of the focus of studies thus far has been on outcomes expected to improve with intensive dialysis such as BP and phosphorous control. In this issue of JASN, 6 Suri and colleagues provide detailed analyses of vascular access outcomes from the two Frequent Hemodialysis Network (FHN) trials, the largest randomized controlled trials of frequent maintenance hemodialysis.…”

Evidence-Based Cardiology in Hemodialysis Patients

“…40 Three RCTs have compared survival and cardiovascular events in patients allocated to HDF versus conventional hemodialysis. One study observed better outcomes with HDF, 41 whereas the other two studies found no difference.…”