Principles and Practices of Haemodiafiltration

Abstract

Options for renal replacement therapy (RRT) for patients with end-stage kidney disease (ESKD) include haemodialysis, peritoneal dialysis and renal transplantation. Although renal transplantation offers the best outcomes in terms of quality and quantity of life, most patients with ESKD will be treated with dialysis, either because they are ineligible for transplantation due to their burden of comorbid medical conditions, or because they commonly have to wait several years on dialysis before they are able to receive a kidney transplant. Survival of patients on dialysis remains poor, with reported annual mortality rates ranging from 12.7% in Australia and 14.6% for New Zealand [1] to 17.9% in Europe [2] to 25% in the United States of America [3]. Alternative ways of delivering dialysis that will materially improve patient outcomes are therefore required. Emerging data suggest that haemodiafiltration (HDF), a form of haemodialysis that combines both diffusive and convective solute removal, may offer clinical benefits when compared to standard high-flux haemodialysis (HD). Despite these findings, the global uptake of haemo‐ diafiltration is variable and generally low, ranging from minimal use in the United States, 3.1% in the United Kingdom to 6% in Australia and 28.8% in Belgium [2]. This chapter will provide an overview of the principles and technical aspects of haemodiafiltration, as well as review the clinical evidence comparing HDF outcomes with those of HD. 2.