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On-line hemodiafiltration: technique and therapy.

I Ledebo1

  • 1Gambro Renal Care R&D, Lund, Sweden. ingrid.ledebo@gambro.com

Advances in Renal Replacement Therapy
|May 7, 1999
PubMed
Summary

On-line hemodiafiltration (HDF) offers superior blood purification compared to traditional dialysis. Its cost is offset by significant therapeutic benefits, making it an effective renal replacement therapy.

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Area of Science:

  • Nephrology
  • Biomedical Engineering

Background:

  • On-line hemodiafiltration (HDF) represents an advanced form of renal replacement therapy.
  • It offers a broader spectrum of blood purification compared to conventional dialysis methods.
  • Current HDF systems utilize state-of-the-art dialysis membranes and treatment technologies for enhanced biocompatibility.

Purpose of the Study:

  • To evaluate the efficacy and safety of on-line hemodiafiltration.
  • To assess the economic viability and therapeutic benefits of HDF.
  • To detail the optimal parameters and preparation methods for on-line HDF.

Main Methods:

  • On-line HDF involves generating sterile, pyrogen-free substitution fluid from dialysate via stepwise ultrafiltration.
  • Substitution fluid is administered, preferably in postdilution mode, to replace ultrafiltered volume (20-30 liters per treatment).
  • Key factors for optimal substitution fluid preparation include water quality, concentrate purity, ultrafilter integrity, and microbiological control of the system.

Main Results:

  • On-line HDF achieves a greater clearance of solutes across a wide molecular weight range compared to high-flux dialysis with identical membranes.
  • The biocompatibility of on-line HDF is comparable to the highest standards achievable with current technologies.
  • Clinical studies and long-term user data confirm the safety of on-line prepared substitution fluid.

Conclusions:

  • On-line HDF provides superior blood purification and therapeutic benefits that justify its costs.
  • Optimal performance requires maximizing the ultrafiltration rate relative to blood flow rate.
  • The preparation of sterile, pyrogen-free substitution fluid is critical for the clinical safety and efficacy of on-line HDF.

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