HDF is a renal replacement technique combining two principles – diffusion and convection. The convective process is based on the ultrafiltration of large amounts of plasma water across the membrane. This allows for the effective removal of larger solutes due to convection in addition to the diffusive transport of small molecules.
To maintain the fluid balance it is necessary to replace the additional ultrafiltration volume, ideally after the dialyser, the so-called post-dilution HDF.
Volume matters in haemodiafiltration
Recent publications have demonstrated that a large convective volume in post-dilution mode is required in order to maximise the benefits of HDF therapy.1-7 According to the Catalonian high-volume HDF study a substitution volume (without allowing for weight loss) of at least 21 L per treatment in post-dilution mode should be the target to derive the survival benefit1. The production of large amounts of substitution volume is no longer a challenge. Today maximising substitution volume for each patient requires a new therapeutic approach – HighVolumeHDF.
1 Maduell F. et al., J Am Soc Nephrol (2013); 24: 487-497.
2 Ok E. et al., Nephrol Dial Transplant (2013); 28: 192-202.
3 Grooteman M.P. et al., J Am Soc Nephrol (2012); 23: 1087-96.
4 Canaud B. et al., Kidney Int (2006); 69: 2087-93.
5 Mostovaya I.M. et al., Semin Dial (2014); 27(2): 119-127.
6 Peters S.A.E. et al., Nephrol Dial Transplant (2016); 31: 978-984.
7 Basile C. et al., J Nephrol (2017); 30(2): 181-186.