Development of hemodiafiltration therapy--a historical perspective

Hemodiafiltration (HDF) was created in the late 1970s to combine the best of hemodialysis (HD) and hemofiltration, i.e. superior removal of both small and large solutes. Thus, optimal conditions for both diffusion and convection are required. The need for large volumes of sterile fluid has shaped the evolution of HDF, and regulatory issues around systems for on-line fluid preparation have delayed the clinical development of the therapy. Not until such systems became generally available in the mid-1990 s was it possible to increase the efficiency of HDF therapy to match and exceed the upgrade that had taken place for HD. Results from recent studies indicate that the potential for improving the outcome of dialysis lies in increasing the convective clearance of HDF above that of high-flux HD.