Optimizing the prescription of hemodiafiltration

Hemodiafiltration with larger amounts of substitution fluid offers an optimal way to remove uremic substances. Hemodiafiltration could be indicated for all hemodialysis patients. Large observational studies have shown an association of a lower mortality risk with hemodiafiltration using more than 15 liters of substitution fluid. Specific indications should be considered because hemodiafiltration has been reported to be effective against hyperphospatemia, malnutrition, insomnia, irritability, restless-leg syndrome, polyneuropathy, anemia, itching and joint pain, and may prevent dialysis-associated amyloidosis. In this chapter, hemodiafiltration prescriptions concerning blood and dialysate fl ow, infusion rate, vascular access and frequency are detailed.