Techniques and kinetics of hemodiafiltration

Abstract

Medium-long-term application of on-line high-efficiency HDF compared to low- and high-flux HD results in enhanced removal and lower basal levels of small, medium and protein-bound uremic solutes, some of which are retained as markers or causative agents of several uremic derangements, mainly inflammation, secondary hyperparathyroidism, dyslipidemia and cardiovascular disease. Probably, many of the benefits attributed to HDF potentially result from a general reduction of the uremic toxicity. This might be the link with the clinical benefits reported in patients undergoing chronic HDF which eventually contribute to improving patients survival, as suggested by published observational studies. However, In the absence of large randomized, prospective studies, it is reasonable to conclude that online HDF is a logical and safe therapy effective in maintaining the life and wellbeing of dialysis patients. Knowledge of the performance of materials, apparatus and devices used in HDF, and study of the solute transport mechanisms with the aid of modelling simulation will help to optimize this technique and obtain additional clinical benefits. © 2013 Springer-Verlag Berlin Heidelberg.