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Chronic intermittent high-volume hemodiafiltration

Muriel PC Grooteman, MD, PhD
Peter J Blankestijn, MD
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD


Hemodiafiltration (HDF) is a form of renal replacement therapy that utilizes convective in combination with diffusive clearance, which is used in standard hemodialysis. Compared with standard hemodialysis, HDF removes more middle-molecular-weight solutes. Some, though not all, studies have suggested that HDF is associated with improved clinical outcomes, providing adequate convection volumes are achieved.

However, HDF is more complex than standard hemodialysis and places increased demands on the user and outpatient dialysis center. HDF is not available in the United States. In Europe, Japan, and some other countries where HDF is available, most clinicians use a specific type of HDF termed online HDF. In online HDF, the substitution fluid is produced by the dialysis machine, which enables large convection volumes.

The use of chronic maintenance HDF requires changes in infrastructure in outpatient dialysis units. Decisions to implement such changes are made on a corporate level, although, when HDF is available in a given center, the practicing clinician can decide to perform either HDF or standard hemodialysis in individual patients. Indications for HDF in individual patients have not been identified. The possible beneficial effect of online HDF on survival is consistent in different patient groups (including age, gender, dialysis vintage, absence or presence of residual kidney function, diabetes) [1].

This topic reviews dosing recommendations and clinical outcomes for HDF.

The technical aspects of HDF, including established guidelines for its implementation, are discussed elsewhere. (See "Technical aspects of hemodiafiltration".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 01, 2016.
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