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Overcoming the limitations of post-dilution on-line hemodiafiltration: mixed dilution hemodiafiltration
Abstract:
The impact of hemodiafiltration (HDF) on survival is still a topic of under investigation. Most recently, the results of two large prospective trials (the CONTRAST Study and the Turkish HDF Study) did not find any difference in survival between on-line HDF versus low- and high-flux hemodialysis (HD) in the overall dialysis population. However, secondary subgroup analyses of both studies showed a significant reduction in death risk among patients on HDF with high volume exchange, confirming the preliminary observation of the European DOPPS Study. Higher middle molecule removal is definitely attained in high-efficiency HDF compared to high-flux HD, and lower basal β(2)-microglobulin levels may result in reduced death risk, as suggested by an analysis of the HEMO Study.
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