Abstract:Hemodiafiltration (HDF), in which both convective and diffusion methods are combined, yields an increased overall solute clearance compared with hemodialysis (HD), specifically for medium and larger molecular weight uremic toxins. Due to uncertainty in the treatment effects, the nephrology community still perceives the implementation of HDF and the achievement of high convective volume as complex.In this article, we review practical aspects of the implementation of HDF that can effectively deliver a high-volum… Show more
“…Larger gauge needles – 14G or 15G – are recommended to enable adequate convection volumes 16 , 18 , 22 , 23 . The dialysis solution formulations used in online HDF are the same as the ones used in conventional hemodialysis.…”
Section: Equipment Supplies and Dialyzersmentioning
confidence: 99%
“…Recommendations stress a preference for using solutions with glucose, potassium > 2 mEq/L and bicarbonate 32 mEq/L. Calcium concentration, usually set at 2.5 or 3 mEq/L, must be individualized 1 , 16 , 22 , 24 .…”
Section: Equipment Supplies and Dialyzersmentioning
confidence: 99%
“…Blood flow might be the single most important variable for achieving adequate convection volumes. There is a direct relationship between convection volume and effective blood flow 14 , 15 , 17 , 22 . To maintain an effective blood flow of at least 350 mL/min, good vascular access and monitoring arterial and venous pressure in the vascular access are required.…”
Section: Strategies For Achieving Adequate Convection Volumesmentioning
confidence: 99%
“…To maintain an effective blood flow of at least 350 mL/min, good vascular access and monitoring arterial and venous pressure in the vascular access are required. Larger gauge needles are recommended for patients with arteriovenous fistulas or grafts 16 , 17 , 22 , 23 , 30 . In patients with a central venous catheter, achieving high blood flows depends on the model and diameter of the lumen of the catheter 30 .…”
Section: Strategies For Achieving Adequate Convection Volumesmentioning
Online hemodiafiltration (HDF) is a rapidly growing dialysis modality worldwide. In Brazil, the number of patients with private health insurance undergoing HDF has exceeded the number of patients on peritoneal dialysis. The achievement of a high convection volume was associated with better clinical imprand patient – reported outcomes confirming the benefits of HDF. The HDFit trial provided relevant practical information on the implementation of online HDF in dialysis centers in Brazil. This article aims to disseminate technical information to improve the quality and safety of this new dialysis modality.
“…Larger gauge needles – 14G or 15G – are recommended to enable adequate convection volumes 16 , 18 , 22 , 23 . The dialysis solution formulations used in online HDF are the same as the ones used in conventional hemodialysis.…”
Section: Equipment Supplies and Dialyzersmentioning
confidence: 99%
“…Recommendations stress a preference for using solutions with glucose, potassium > 2 mEq/L and bicarbonate 32 mEq/L. Calcium concentration, usually set at 2.5 or 3 mEq/L, must be individualized 1 , 16 , 22 , 24 .…”
Section: Equipment Supplies and Dialyzersmentioning
confidence: 99%
“…Blood flow might be the single most important variable for achieving adequate convection volumes. There is a direct relationship between convection volume and effective blood flow 14 , 15 , 17 , 22 . To maintain an effective blood flow of at least 350 mL/min, good vascular access and monitoring arterial and venous pressure in the vascular access are required.…”
Section: Strategies For Achieving Adequate Convection Volumesmentioning
confidence: 99%
“…To maintain an effective blood flow of at least 350 mL/min, good vascular access and monitoring arterial and venous pressure in the vascular access are required. Larger gauge needles are recommended for patients with arteriovenous fistulas or grafts 16 , 17 , 22 , 23 , 30 . In patients with a central venous catheter, achieving high blood flows depends on the model and diameter of the lumen of the catheter 30 .…”
Section: Strategies For Achieving Adequate Convection Volumesmentioning
Online hemodiafiltration (HDF) is a rapidly growing dialysis modality worldwide. In Brazil, the number of patients with private health insurance undergoing HDF has exceeded the number of patients on peritoneal dialysis. The achievement of a high convection volume was associated with better clinical imprand patient – reported outcomes confirming the benefits of HDF. The HDFit trial provided relevant practical information on the implementation of online HDF in dialysis centers in Brazil. This article aims to disseminate technical information to improve the quality and safety of this new dialysis modality.
“…Short-term benefits are those related to intradialytic or interdialysis effects, such as improved hemodynamic stability, reduced post-treatment fatigue, better weight management, and blood pressure control. Prolonged exposure to this treatment leads to intermediate benefits, including improved nutritional status and phosphorus levels, reduced inflammation and oxidative stress, alleviation of neurological symptoms and joint pain, enhanced response to erythropoietin, and better immune response [ 9 ].…”
Dialysis treatment has improved the survival of patients with kidney failure. However, the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach that significantly improves patient outcomes by effectively eliminating medium and large uremic toxins, which explains its increasing adoption, particularly in Europe and Japan. Interest in this therapy has grown following the findings of the recently published CONVINCE study, as well as the need to understand the mechanisms behind the benefits. This comprehensive review aims to enhance the scientific understanding by explaining the underlying physiological mechanisms that contribute to the positive effects of HDF in terms of short-term benefits, like hemodynamic tolerance and cardiovascular disease. Additionally, it explores the rationale behind the medium-term clinical benefits, including phosphorus removal, the modulation of inflammation and oxidative stress, anemia management, immune response modulation, nutritional effects, the mitigation of bone disorders, neuropathy relief, and amyloidosis reduction. This review also analyzes the impact of HDF on patient-reported outcomes and mortality. Considering the importance of applying personalized uremic toxin removal strategies tailored to the unique needs of each patient, high-volume HDF appears to be the most effective treatment to date for patients with renal failure. This justifies the need to prioritize its application in clinical practice, initially focusing on the groups with the greatest potential benefits and subsequently extending its use to a larger number of patients.
RESUMO A hemodiafiltração (HDF) on-line é uma modalidade dialítica em rápido crescimento no mundo. No Brasil, o número de pacientes com planos de saúde privados tratados por HDF já ultrapassa aquele de pacientes em diálise peritoneal. O alcance de um alto volume convectivo associado à redução de desfechos clínicos e do risco de morte confirmam os benefícios da HDF. Dados nacionais do estudo HDFit forneceram informações práticas relevantes sobre a implementação da HDF on-line em clínicas de diálise no Brasil. O objetivo desta publicação é a disseminação de informações técnicas que possam auxiliar na utilização, com qualidade e segurança, dessa nova modalidade dialítica.
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