Hemodiafiltration Introduction

In the late seventies, convective-based therapies (i.e.Hemofiltration (HF)Hemodiafiltration (HDF) were recognized for their potential clinical benefits (i.e., reduce intradialytic hypotension, improve dialysis tolerance) and increased efficiency on solute removal (i.e., increased removal of middlesized uremic compounds) compared to conventional hemodialysis (HD) as supportive treatment of end stage kidney disease (ESKD) patients (1-4)Soon after, online HDF emerged as aappealing (5) and viable modality (6) to address main concerns (i.e., disease burden, cardiovascular burden, poor quality of life) associated with current renal replacement modalities including high-flux hemodialysis (78) 

HDF has gained, over the last decade, higher clinical acceptance worldwide. As indicated in a recent survey report, HDF has been used to treat 286,000 patients worldwide, of which 278,000 were treated by online HDF (97%) (9). This represents the vast majority of convective therapies (9). Online HDF acceptance is growing faster in the two leading regions (Europe and the Asia Pacific Region including Japan) after having approved the method, with patient average growth rates of 12 to 24% -far above the total patient HD growth rate of 6.6% (9). 

Recognizing HDF as an advanced and promising renal replacement modality for end stage kidney disease patients, it is worthwhile to review clinical evidence regarding potential benefits of HDFas well as  identify gaps and complementary research questions that are needed (1011). 

In this module, scientific reports were clustered according to the level of evidence and degree of clinical importance (12-14). Three categories have been thus established: the first category consists of shortterm prospective studies with focus on intermediary outcomes (e.g., clinical performances, biological effects); the second category consists of large cohort studies reporting intermediary and/or a hard clinical endpoint (mortality); the third category consists of prospective randomized studies and/or meta-analyses of large studies where HDF was the primary intervention. 


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  3. van Kuijk WH, Hillion D, Savoiu C, Leunissen KM. Critical role of the extracorporeal blood temperature in the hemodynamic response during hemofiltration. J Am Soc Nephrol. 1997;8(6):949-55.
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  9. Canaud B, Kohler K, Sichart JM, Moller S. Global prevalent use, trends and practices in haemodiafiltration. Nephrol Dial Transplant. 2020;35(3):398-407.
  10. Blankestijn PJ, Grooteman MP, Nube MJ, Bots ML. Clinical evidence on haemodiafiltration. Nephrol Dial Transplant. 2018;33(suppl_3):iii53-iii8.
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P/N 104622-01 Rev A 02/2021