Adopting on-line hemodiafiltration as standard therapy in EMEA NephroCare centers

This paper describes the historical journey that led to the adoption of on-line hemodiafiltration (HDF) as a standard therapy for the patients in the Fresenius Medical Care (FME) NephroCare dialysis network. In 1998, FME faced the tremendous challenge of consolidating a series of heterogeneous clinics under one umbrella. In 2002, the European Best Practice Guidelines (EBPG) for hemodialysis (HD) were published by the European Renal Association which FME promptly adopted within its clinic network. On the basis of this document, the strategic decision was taken to apply high-flux, biocompatible membranes throughout the entire network. To cope with the effective implementation of this step, the clinics' technical infrastructure was updated. The widespread application of high-flux therapy, together with the implementation of the required infrastructure, especially concerning water quality, opened the way to the extensive use of on-line HDF. To fully realize this ambitious goal, two further technological steps were targeted and successfully reached: introduction of the Fresenius 5008 dialysis equipment and an even stricter control of the water quality. The combined pressure from the educational activities, which brought about a preliminary cultural change, and the creation of a target based on the percentage of treatments by this technique resulted in an increasing implementation of this modality by the individual clinics. After 2004, on-line HDF continuously increased its share among the dialysis techniques prescribed in the network and currently more than 50% of patients are on this modality.