Global prevalent use, trends and practices in haemodiafiltration

Abstract

Online haemodiafiltration (HDF) represents today the most advanced and innovative form of renal replacement therapy (RRT). Recent controlled trials tend to prove its superiority over conventional haemodialysis on hard clinical end points provided that the right convective dose was delivered. In this article we report on present prevalent use and epidemiologic trends of HDF worldwide as well as on practice patterns in HDF prescription. In addition we analyze factors that may affect HDF clinical acceptance and more widely its implementation. National and international renal registries provide valuable demographic and epidemiologic information on end stage kidney disease patients on RRT. However, the updating and maintenance of such information system is particularly challenging at a country level and even more so on an international basis. Lag time, incompleteness and/or imprecision of data collection may further hamper precision and validity of data reporting. Fresenius Medical Care (FMC), as a large dialysis care provider operating worldwide, maintains an annually updated database addressing international end stage kidney disease data. Over the last decade, FMC has produced series of precise and reliable reports analyzing RRT trends and practices worldwide. The present overview and analysis is based on our consolidated data from market survey as well as national database registries and databases of recent studies. Online HDF acceptance is growing fast in the two leading regions having approved the method, i.e. Europe and Asia Pacific, with a patient average growth rate of 12 to 24%, being far above the total patient HD growth rate of 6.6%. Today online HDF represents a new paradigm shift in RRT with promising clinical results. Further initiatives (e.g., Kidney Health Initiative, NICE) might provide further push for promoting HDF as a new standard of care in end stage kidney disease patients on a global scale.

Comparison of Circulating Levels of Uremic Toxins in Hemodialysis Patients Treated with Medium Cut-Off Membranes and High-Flux Membranes: Theranova in Sisli Hamidiye Etfal (THE SHE) Randomized Control Study

“…Today, high-flux hemodialysis is the most common mode of dialysis therapy worldwide while HDF, which is more complex than standard hemodialysis and therefore places increased demands on the dialysis provider, is still not widely accepted. In 2017, 2.82 million ESKD patients were treated by hemodialysis, and among these 10% received online HDF with the highest usage in Europe (26%) followed by Asia Pacific (11%) while the use of HDF as a percentage of all hemodialysis was much lower in North America (<1%) and other regions [3].…”

“…Chronic kidney disease is a major cause of morbidity and mortality in the world [1], and the number of patients with end-stage kidney disease (ESKD) receiving renal replacement therapy is continuously increasing, from 2.5 million in 2010 [2] to 3.17 million in 2017 [3]. In addition to the increasing health care burden imposed by the increasing number of patients requiring dialysis, a major concern is that the high mortality of dialysis patients has not improved much over the last 30 years [4].…”

Eco-dialysis: fashion or necessity

“…Four different trials demonstrated that beta-2 microglobulin (beta2MG) clearance was independent of Qd [21,26,27]. In three studies, scientists did not find significant differences in phosphorus removal between dialysate flow rates of 400 and 500 mL/ min [18,20]. In conclusion, most of the studies did not show the impact of Qd changes on uremic toxins clearance and patients' outcome.…”

“…Now many countries in Europe use these treatment methods for their patients (70% and 50% of HD sessions in Germany and France, respectively). Based on recent controlled trials, high volume substitution is preferred-the minimum threshold convective dose to ensure patient benefits starts at 23 L/1.73 m 2 per session in post-dilution HDF mode [20]. The volume of the infusion solution in classical HDF is limited and 8-10 L of fluid is most commonly used-hence, on-line HDF mode is preferred.…”

“…In all studies, the mean weight of patients was similar, less than 70 kg. Six studies investigated the influence of flow changes on Kt/V [9,20]: five studies showed no significant difference between lower vs higher Qd (400 mL/min vs 500 mL/min or 500 mL/min vs 700 mL/ min); only one study (from Spain) reported a 4% statistically significant increase of Kt between Qd 400 and 500 mL/min and a 2.9% increase from 500 to 700 mL/min [12,24,25]. Two studies focused on clearances for urea and creatinine [24,25] and showed that small solute clearance is highly dependent on dialysate flow rate but only when the dialysate flow rate is much less than 200 mL/min.…”