Optimization of the Convective Dose in On-Line Hemodiafiltration: Prospective Interventional Cohort Study-Conducted...

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Chronic Kidney Disease Management

Background:

• On-line hemodiafiltration (OL-HDF) is a proposed alternative to conventional hemodialysis (HD) for end-stage chronic kidney disease (CKD).
• High convection volume (CV) in OL-HDF may reduce mortality, but achieving target CV (≥23 L/1.73 m² per session) is challenging in routine practice.
• The CONVINCE trial showed high success with a structured protocol, but its real-world applicability in unselected populations is uncertain.

Purpose of the Study:

• To evaluate the incidence of achieving high CV in OL-HDF among unselected patients.
• To assess the effectiveness of a standardized optimization protocol under routine conditions.
• To determine if a structured approach can sustain high CV and improve dialysis adequacy.

Main Methods:

• Prospective cohort study involving 67 unselected incident and prevalent CKD patients.
• Patients were switched to post-dilution OL-HDF using the CONVINCE optimization protocol.
• Protocol included stepwise increases in blood flow, filtration fraction adjustment, and session duration optimization.

Main Results:

• Blood flow increased significantly (283 to 338 mL/min), and use of larger dialyzers increased (36% to 68%).
• Mean Kt/V improved from 1.22 to 1.6, indicating enhanced dialysis adequacy.
• High CV (23.5 L/session) was sustained in 62.3% of patients, correlating positively with blood flow, session duration, and Kt/V.

Conclusions:

• A stepwise optimization protocol can enable sustained achievement of high CV in a majority of unselected OL-HDF patients.
• This protocol improves dialysis adequacy and demonstrates feasibility in routine clinical practice.
• The findings support the wider adoption of standardized optimization for OL-HDF in CKD management.