Abstract
ABSTRACTOnline hemodiafiltration is potentially a superior mode of dialysis compared to conventional hemodialysis. However, prospective randomized controlled trials have failed to demonstrate such superiority. Post-hoc analyses of these trials have indicated that high volume post-dilution hemodiafiltration is associated with lower death rates than conventional dialysis. This study discusses whether the lower death rates ascribed to high volume hemodiafiltration are linked to convection volume or the time on dialysis needed to achieve high convection volumes.
Highlights
Despite the improvements made to dialysis equipment and supplies, death rates still remain elevated
In 1981, the National Cooperative Dialysis Study (NCDS) showed that increases in dialysis dose were associated with decreases in death rates[1]
The HEMO (Hemodialysis) Study evaluated the effects of dialysis dose and high flux membranes on patient mortality[5]
Summary
Despite the improvements made to dialysis equipment and supplies, death rates still remain elevated. In 1981, the National Cooperative Dialysis Study (NCDS) showed that increases in dialysis dose were associated with decreases in death rates[1]. Attempts to extend time on dialysis were not made, since patients, physicians, and dialysis staff have resisted the idea, and a national study conducted in the United States failed to report lower death rates when time on dialysis was increased. In this setting, the last four to five decades have seen the development and Hemodiafiltration in clinical practice introduction in clinical practice of different approaches to hemodialysis aimed to decrease mortality. This study interprets and discusses previously published trials in an integrated, sequential manner
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