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NDT Advance Access originally published online on May 21, 2008
Nephrology Dialysis Transplantation 2008 23(8):2705-2706; doi:10.1093/ndt/gfn283
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© The Author [2008].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


HDF promise for the future

E-mail: willy.lornoy.heusden{at}pandora.be

Sir,

The February issue of Nephrology Dialysis Transplantation amply reported on online haemodiafiltration (HDF) as a possible promise for the future [1].

Please note the following erratum in Table 1 of the Editorial Comment, concerning our study with reference 16: high-volume HDF in postdilution was compared with high-flux haemodialysis (hfHD) with regard to the removal of beta2-microglobulin (b2M) and not with low-flux HD (lfHD), as is reported.

Although most studies with online HDF demonstrate a higher removal of a broad range of the molecular spectrum of uraemic compounds versus HD, confusion still persists on the preferred method of HDF. With regard to the location of inflow of the substitution fluid, most studies rely on post-, pre-, mid- or mixed dilution, but this results in different removal rates. It is regrettable that in several references in the Editorial Comment, even the used HDF method was not mentioned (Table 1). Yet this is essential for the knowledge of the efficiency of the treatment. For instance, it is well known that with high-volume predilution HDF, a lower clearance of small molecules is achieved versus high-flux HD. Besides, a lower b2M clearance is noted in high-volume predilution HDF, compared with postdilution HDF with the same amount of substitution volume (80 ml/min) [2]. In view of these results, it is not surprising that in the ongoing trials in the Netherlands and France high-volume HDF in postdilution is chosen.

It is also stated in the Editorial Comment that conflicting results concerning phosphate clearance were reported. When comparing phosphate removal with high-volume (100 ml/min) HDF in postdilution, our group observed a 19% higher removal versus high-flux HD [3].

Finally—as in our department, routine high-volume postdilution HDF is performed since 1993—in dialysis patients with more than 10 years of treatment, a lower prevalence of carpal tunnel syndrome is reported in reference 16 of the Editorial Comment. Concerning survival, recently our group reported a 26% survival benefit [4], comparable with the data of the DOPPS study and of the observational study from Eastern Europe.

Conflict of interest statement. None declared.

Willy Lornoy and Johan De Meester

Department of Nephrology, Dialysis and Hypertension, Onze Lieve Vrouwziekenhuis, Aalst, Belgium

References

  1. Van Der Weerd NC, Penne EL, Van Den Dorpel MA, et al. Haemodiafiltration: promise for the future? Nephrol Dial Transplant (2008) 23:438–443.[Free Full Text]
  2. Lornoy W, Becaus I, Billiouw JM, et al. Remarkable removal of beta-2-microglobulin by on-line hemodiafiltration. Am J Nephrol (1998) 18:105–108.[CrossRef][Web of Science][Medline]
  3. Lornoy W, De Meester J, Becaus I, et al. Impact of convective flow on phosphorus removal in maintenance hemodialysis patients. J Ren Nutr (2006) 16:47–53.[CrossRef][Web of Science][Medline]
  4. De Meester J, Van Langenhove P, Van Vlem B, et al. Survival benefit of hemodiafiltration: a single center experience. ASN Renal Week (2007) 6:2402. (abstract).

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This Article
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