NDT Advance Access published online on November 28, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm791
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Haemodiafiltration: Promise for the Future?
1 Department of Nephrology, University Medical Center, Utrecht 2 Department of Nephrology, Vrije Universiteit Medical Center, Amsterdam 3 Department of Nephrology, Medical Center Rijnmond Zuid, Rotterdam 4 Department of Nephrology, Medical Center Alkmaar 5 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
Correspondence and offprint requests to: Peter J. Blankestijn, University Medical Center, Department of Nephrology, Room F03.226, PO BOX 85500, 3508 GA Utrecht, The Netherlands. Tel: +31-88-7557329; Fax: +31-30-2543492; E-mail: P.J.Blankestijn@umcutrecht.nl
Keywords: haemodialysis; on-line haemodiafiltration
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Introduction |
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During haemodiafiltration (HDF), diffusive and convective transport are combined for the removal of waste solutes. Fluid removal exceeds the desired weight loss, and fluid balance is maintained by infusion of a sterile pyrogen-free solution. This dialysis modality may offer advantages, as compared to haemodialysis (HD) or haemofiltration (HF) used separately.This brief editorial comment summarizes currently available knowledge on technical and (pre-)clinical aspects of HDF, as well as currently ongoing trials.
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Theoretical background |
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In HDF, not only small molecules (<5 kDa) are removed more effectively as compared to low-flux HD, but in addition, a considerable clearance of so-called middle molecular weight (MMW) substances (5–50 kDa) is obtained [1]. Beta2-microglobulin (ß2M, MW 11.8 kD) is a typical example of this category and is strongly associated with the presence of carpal tunnel syndrome and dialysis-related amyloidosis in chronic HD patients. In the HEMO study (see details below), predialysis ß2M levels were associated with
High-flux HD and low-efficiency HDF
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Technical considerations |
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Evaluation of olHDF as renal replacement therapy: effects on (pre-)clinical variables and survival |
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Preclinical variables
Clinical variables
Survival
Ongoing trials
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Conclusion |
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