What Can We Expect from On-Line Hemodiafiltration?

Abstract

On-line hemodiafiltration (ol-HDF) may improve clinical outcome in ESRD. The supposed mechanism is the improved clearance of uremic toxins by convective transport which is added to the diffusion transport. However, recent marked improvement in the performance of dialyzers has allowed higher removal rate of middle to large solutes by diffusion. It is inaccurate to define substances with a higher molecular weight such as uremic toxins. In addition, new methods should be developed for the removal of protein-bound substances. A technical fee for on-line HDF was newly established on the revision of the reimbursement for medical services Japan in 2012 and clearly separated from off-line HDF. As a facility requirement, the calculation of ‘addition for maintaining dialysis fluid water quality' was added. Evidence for the clinical effects of ol-HDF have been reported mainly in Europe but is still inaccurate. To confirm the effectiveness of ol-HDF, randomized comparative trials on hemodialysis using super high-flux dialyzers and ol-HDF with same performance hemodiafilter are necessary.

Significant Fluctuations in Total Complement Hemolytic Activity as a Nutritional Parameter After Transition from Hemodialysis to Online Hemodiafiltration

“…Although dialysis fluid purification by OLHDF has several clinical benefits 13) 14) , serum proteins, such as albumin (Alb), that can bind to uremic toxins may also be eliminated 15) 16) . Removal of Alb, which has a half-life of about 14 days, was observed to some extent in a previous study 17) . Furthermore, studies suggest that protein wasting is related to morbidity and mortality in patients receiving maintenance HD 18) 19) .…”

Development of online hemodiafiltration in Japan

“…However, it is difficult to indicate the effects separately. Furthermore, the presence or absence of synergistic effects remains to be clarified [15]. The clinical effects and mortality according to symptom (observational study and randomized controlled trial [RCT]) are shown in Table 1 and Table 2, respectively.…”

“…Although in Japan, ol-HDF started in 1993, concerning payment for medical services, inaccurate circumstances persisted [15]. At the beginning of 2010, an ol-HDF machine for a central dialysis fluid delivery system was approved as a multi-purpose dialysis system, thus ol-HDF became a general procedure in dialysis therapy.…”

Effects of Different Blood Purification Methods on Serum Cytokine Levels and Prognosis in Patients With Acute Severe Organophosphorus Pesticide Poisoning

“…However, the application of CBP is limited due to its high cost and lack of equipment in rural hospitals. OL‐HDF is another blood purification method developed recently; it is a highly efficient RRT that combines dialysis and filtration . This method uses a high‐throughput synthetic membrane and on‐line generation of replacement fluid to clear solutes by diffusion, convection, and adsorption.…”