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NDT Plus Advance Access published online on November 5, 2009
NDT Plus, doi:10.1093/ndtplus/sfp149
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© The Author 2009. Published by Oxford University Press. [on behalf of ERA-EDTA].
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Haemodiafiltration—optimal efficiency and safety

Ingrid Ledebo1 and Peter J. Blankestijn2

1 Gambro Research and Development, Lund, Sweden
2 Department of Nephrology, UMC Utrecht, Utrecht, The Netherlands

Correspondence: Ingrid Ledebo; E-mail: ingrid.ledebo{at}gambro.com


  Abstract

Haemodiafiltration (HDF) is the blood purification therapy of choice for those who want significant removal of uraemic solutes beyond the traditional range of small molecules. Combining diffusive and convective solute transport, a HDF treatment comprises the largest number of variables among blood purification therapies, and it is important to understand how they interact in order to optimize the therapy. This review discusses the parameters that determine the efficiency of HDF and how they can be controlled in the different forms of HDF and ‘HDF-like’ therapies practised today. The key to safe and effective HDF therapy is to have access to large volumes of high-quality fluids. Starting with ultrapure dialysis fluid, on-line preparation of a sterile, non-pyrogenic substitution solution can be made an integral part of the treatment, and we describe the necessary conditions for this. On-line HDF can provide the largest removal of the widest range of solutes among available dialysis therapies, and the potential clinical benefits of this are within practical reach for the increasing number of patients dialysed with high-flux membranes and ultrapure dialysis fluid.

Key Words: convection • haemodiafiltration • on-line fluid preparation • postdilution • predilution

Received for publication July 30, 2009. Accepted for publication September 25, 2009.


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