Abstract
The reduction of the dismally high mortality of current end-stage renal disease patients maintained on conventional standard haemodialysis (HD) remains an unmet medical need. Online haemodiafiltration (HDF) modes with various sites of fluid substitution (post-, pre-, mixed- and mid-dilution) are increasingly used worldwide as promising alternatives to conventional HD. Large scale cohort studies, post hoc analyses of randomized trials, and individual participant meta-analyses suggest that post-dilution and pre-dilution, especially with high substitution volumes, improve outcomes compared with conventional standard HD. However, there is no definitive proof of a survival advantage of HDF over standard HD. The different modes of high-volume HDF should be considered a therapeutic platform allowing to personalize and tailor routine HDF treatment. The selection of the HDF mode should be made according to individual patient characteristics. Utilizing high retention onset membranes, expanded haemodialysis (HDx) can achieve the same solute removal performance as HDF. Subgroups of high-volume OL-HDF patients could benefit from HDx. Ongoing and future trials should provide definitive proof for the superiority of high-volume OL-HDF over conventional HD or HDx to give guidance for the most favourable mode of dialytic therapy for clinical use.
Highlights
Patients with end-stage renal disease (ESRD) maintained on dialysis have a shortened life expectancy and impaired quality of life compared to their peers without kidney disease, despite improvements in medical treatment
Preliminary results of its clinical application indicate that trans-membrane pressure (TMP)- modulated mixed-dilution Online haemodiafiltration (OL-HDF) could be one of the most powerful strategies to prevent or delay the occurrence of some long-term dialysis complications and to promote improved survival of ESRD patients [6]
No significant differences in the removal ratio (RR) of small and middle molecules, and the global removal scores were observed between Medium cut-off (MCO) and HDF dialyzers
Summary
Patients with end-stage renal disease (ESRD) maintained on dialysis have a shortened life expectancy and impaired quality of life compared to their peers without kidney disease, despite improvements in medical treatment. The ongoing CONVINCE study, a large, international, multi-centre, randomized, controlled trial is set out to prove the superiority of high-dose post-dilution OL-HDF as compared to high-flux standard HD in terms of morbidity, mortality, and health-related quality of life [14]. Preliminary results of its clinical application indicate that trans-membrane pressure (TMP)- modulated mixed-dilution OL-HDF could be one of the most powerful strategies to prevent or delay the occurrence of some long-term dialysis complications and to promote improved survival of ESRD patients [6]. This mode of OL-HDF is not widely used and available data are preliminary. Further clinical studies are needed to assess whether the HDx may improve the outcome of ESRD patients
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