Kidney Week Educational Symposia-The Role of Hemodiafiltration in the Management of Dialysis-Dependent Chronic Kidney Failure

Video Transcription

Video Summary

This symposium reviews the role of online hemodiafiltration (HDF) in dialysis-dependent kidney failure, emphasizing its growing relevance amid the global rise in dialysis, particularly in Asia and China. Speakers distinguish post-dilution versus pre-dilution HDF, noting Europe predominantly uses post-dilution while Japan largely uses pre-dilution, often influenced by blood-flow limitations.<br /><br />High-volume online post-dilution HDF aims to improve removal of middle and larger molecules (e.g., beta-2 microglobulin) rather than simply increasing small-solute clearance. Clinical implementation depends on “six pillars”: blood flow (higher flows enable higher convection volumes), dialyzer selection (high permeability with minimal albumin loss), machine capabilities (automated filtration control to maintain convection and reduce alarms), dialysate optimization (potentially lower flow to save water), electrolyte management, and anticoagulation strategy.<br /><br />Evidence from European trials and an individual patient data meta-analysis suggests HDF can reduce all-cause and cardiovascular mortality, especially when convection volumes exceed ~23 L/session (or ~15 L/m²). The large CONVINCE trial showed a significant survival benefit (HR ~0.77) and more favorable trajectories in patient-reported quality of life, particularly physical and cognitive domains, though absolute differences were modest. Discussion addressed feasibility with catheters, hemodynamic stability (less intradialytic hypotension), and practical selection between pre- and post-dilution modes.

Asset Subtitle

Moderator(s): Philip Li

Presentation(s):

Introduction - Philip Li
The Technological Aspects of HDF - Bernard Canaud
Effect of HDF on the Quality of Life and Mortality of Patients: A Review of the Randomized Clinical Trials - Muriel Grooteman

Support is provided by an educational grant from Fresenius Medical Care Renal Therapies Group LLC.

Meta Tag

Date 10/25/2024

Pathway 1 Dialysis

Session ID 493312

Session Type ES - Educational Symposium

Keywords

online hemodiafiltration

dialysis-dependent kidney failure

post-dilution HDF

pre-dilution HDF

high-volume convection

beta-2 microglobulin removal

convection volume threshold 23 L per session

CONVINCE trial survival benefit

intradialytic hypotension and hemodynamic stability