Preferred performance of the high-performance membrane in the case of online hemodiafiltration

High-performance membrane (HPM) dialyzers have become commonly used in online hemodiafiltration (ol-HDF). HPM dialyzers with a markedly improved function of removing high-molecular solutes have appeared, but excessive albumin loss often occurs using these. Higher albumin loss was observed when these protein-permeable dialyzers were used for post-dilution ol-HDF. When albumin loss is regarded as the criterion, dialyzers with a 0.5 g or lower albumin loss in the hemodialysis mode should be used for post-dilution HDF, whereas those with a 2 g or greater albumin loss should be selected for pre-dilution HDF. The performance of recent HPM dialyzers has been markedly developed, and equivalent removal efficiency can now be achieved with non-ol-HDF. To demonstrate the efficacy of ol-HDF, it is necessary to compare hemodialysis and ol-HDF using a type V dialyzer (β(2)-microglobulin clearance ≥70 ml/min) classified in Japan, and re-investigate the significance of removing high-molecular solutes larger than β(2)-microglobulin and protein-bound solutes.