English

H Schiffl,Sm Lang

doi:10.13172/2053-0293-1-2-1026

Abstract

English

Highlights

Renewed interest in convective renal replacement therapy is fuelled by the desire to reduce high mortality of current maintenance dialysis patients
There is an urgent need to define the required minimum/optimal convection volumes in endstage renal disease patients who are eligible for online haemodiafiltration by well-designed trials
Current renal replacement therapies of end-stage renal disease (ESRD) should not be considered as competing therapeutic options, rather as complementary methods of dealing with uraemia

Summary

Discussion

The authors have referenced some of their own studies in this review. These referenced studies have been conducted in accordance with the Declaration of Helsinki (1964) and the protocols of these studies have been approved by the relevant ethics committees related to the institution in which they were performed. The investigators of the CONTRAST trial randomly assigned 714 prevalent (>2 years) haemodialysis patients to online post-dilution HDF or to continued low-flux haemodialysis. In the Turkish OL-HDF study, 782 prevalent haemodialysis patients were randomly assigned to either post-dilution HDF or high-flux haemodialysis. There is no doubt that inadequate achievement of target ultrafiltration volume represents a severe protocol violation that may invalidate primary objectives of the CONTRAST study It is not clear why some patients who were randomised to highvolume post-dilution OL-HDF were able to achieve target convection volumes, but others were not. The mechanisms through which high convection volumes reduce mortality from cardiovascular or infectious disorders remain elusive It is not clearly understood whether the benefits of high-efficiency HDF on patient survival partly depend on higher clearance of toxic uraemic molecules, less systemic inflammation and/or lower episodes of intradialytic hypotension. Threshold concentration of β2-microglobulin cannot be established as a risk reference indicator without measuring residual renal function during HDF for ESRD patients receiving renal replacement therapy

Conclusion

Introduction

Findings