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Nephrol Dial Transplant (2002) 17: 2065-2070
© 2002 European Renal Association-European Dialysis and Transplant Association

Invited Comment

Optimizing renal replacement therapy—a case for online filtration therapies?

Charles H. Beerenhout1, Jeroen P. Kooman1,, Antinus J. Luik2, Suzanne G. J. Jeuken-Mertens2, Frank M. van der Sande1 and Karel M. L. Leunissen1

1 Department of Internal Medicine/Nephrology, University Hospital Maastricht, Maastricht and 2 Department of Internal Medicine, St. Maartens Gasthuis, Venlo, The Netherlands

Keywords: convective therapy; online filtration; solute clearance; sterility

The first 150 words of the full text of this article appear below.

Introduction

Ideally, renal replacement therapies (RRT) would mimic the function of the normal kidney. However, this goal is not approached both by the discontinuous nature of the treatment and by the fact that the clearance characteristics of the artificial kidney do not even approximate those of the normal human kidney. Haemodialysis and, to a somewhat lesser degree, peritoneal dialysis, which mainly operate by diffusion, preferably remove small molecules but do not remove a large amount of larger molecules that are normally cleared by the kidney. In contrast, haemofiltration (HF) and haemodiafiltration (HDF) are treatment modalities that, due to their convective nature, more closely approach the function of the normal kidney [1]. However, after a burst of initial attention, enthusiasm for these techniques declined during the 1980s, probably because of economic motives due to the high costs of the pharmaceutically prepared substitution fluid and, in the case of HF, because . . . [Full Text of this Article]

Potential role of middle molecules in dialysis-related complications

Aspects of solute clearance

Safety aspects

Costs

Influence of convective techniques on short-term complications

Influence of convective techniques on long-term complications

Conclusion


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