Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond
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Date
2023
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Abstract
Dialysis treatment has improved the survival of patients with kidney failure. However,
the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic
toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach
that significantly improves patient outcomes by effectively eliminating medium and large uremic
toxins, which explains its increasing adoption, particularly in Europe and Japan. Interest in this
therapy has grown following the findings of the recently published CONVINCE study, as well as
the need to understand the mechanisms behind the benefits. This comprehensive review aims to
enhance the scientific understanding by explaining the underlying physiological mechanisms that
contribute to the positive effects of HDF in terms of short-term benefits, like hemodynamic tolerance
and cardiovascular disease. Additionally, it explores the rationale behind the medium-term clinical
benefits, including phosphorus removal, the modulation of inflammation and oxidative stress, anemia
management, immune response modulation, nutritional effects, the mitigation of bone disorders,
neuropathy relief, and amyloidosis reduction. This review also analyzes the impact of HDF on
patient-reported outcomes and mortality. Considering the importance of applying personalized
uremic toxin removal strategies tailored to the unique needs of each patient, high-volume HDF
appears to be the most effective treatment to date for patients with renal failure. This justifies the
need to prioritize its application in clinical practice, initially focusing on the groups with the greatest
potential benefits and subsequently extending its use to a larger number of patients.
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Keywords
Hemodiafiltration, Kidney failure, Dialysis, Uremic toxins, Hemodynamic tolerance, Cardiovascular disease, Inflammation, Oxidative stress, Patient-reported outcomes, Mortality