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Controversies and issues in hemodiafiltration therapy
1National Institute of Health and Medical Research, INSERM U507, Department of Nephrology, Hospital Necker, Paris, France. man@necker.fr
Blood Purification
|January 19, 2005
Summary
Hemodiafiltration (HDF) offers optimal molecule transfer but lacks mortality benefits over hemodialysis (HD). Daily hemodialysis may provide a more stable internal environment for patients with kidney failure.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Biomedical Engineering
Background:
- Hemodiafiltration (HDF) is considered a highly effective renal replacement therapy (RRT) due to its capacity for optimal small and middle molecule transfer.
- Despite theoretical advantages, HDF has not demonstrated a significant reduction in mortality risk compared to traditional hemodialysis (HD).
Discussion:
- Potential drawbacks of HDF include impaired cardiac function and carbonyl stress from acetate in dialysate, and malnutrition due to amino acid and vitamin loss.
- Online preparation of substitution fluid in HDF poses a risk of infusing contaminated fluid, necessitating strict maintenance and quality control protocols for sterility and pyrogenicity.
- The infusion of large volumes of dialysate with residual acetate (2-7 mmol/l) may negatively impact cardiac function.
Key Insights:
- No significant difference in mortality risk exists between patients undergoing HDF and HD.
- Malnutrition and cardiac dysfunction are potential adverse effects associated with HDF.
- Stringent quality control is essential for on-line prepared substitution fluids in HDF.
Outlook:
- Daily hemodialysis, performed frequently, emerges as a promising RRT modality for maintaining a stable internal milieu.
- Further research is needed to optimize HDF protocols and mitigate associated risks.
- Future RRT strategies should focus on improving patient outcomes and quality of life.