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    Area of Science:

    • Nephrology
    • Renal Replacement Therapy
    • Dialysis Technology

    Background:

    • Standard low-flux hemodialysis (HD) has limited efficacy and high patient morbidity/mortality.
    • High-flux HD (hf-HD) demonstrated a 37% relative risk reduction in mortality for patients with low serum albumin.
    • Online hemodiafiltration (HDF) utilizes high-flux membranes for enhanced solute clearance.

    Purpose of the Study:

    • To evaluate the impact of online HDF on patient mortality and morbidity.
    • To compare the efficacy of online HDF against high-flux HD.

    Main Methods:

    • Analysis of three recent randomized trials comparing online HDF with hf-HD.
    • Review of four recent meta-analyses on convective treatments.
    • Examination of post hoc analyses focusing on convection volumes in HDF.

    Main Results:

    • Two randomized trials found no significant survival benefit for HDF over hf-HD.
    • One trial showed significantly better survival with HDF compared to hf-HD.
    • Post hoc analyses suggest higher convection volumes in HDF may reduce mortality and cardiovascular events.
    • Meta-analyses show inconsistent effects on survival but consistent reduction in intradialytic hypotension with HDF.

    Conclusions:

    • The overall effect of online HDF on patient survival remains inconclusive.
    • Convective treatments, including HDF, consistently reduce intradialytic symptomatic hypotension.
    • Further trials are needed to specifically assess the impact of increased convection volumes in online HDF on patient survival and morbidity compared to hf-HD.