Nephrology Dialysis Transplantation On-line haemodiafiltration : state of the art

Faced with the shortcomings of conventional and routinely performed treatment modality for enddialysis on a long-term basis, as illustrated by the stage renal failure (ESRF) patients. Long-term dialysis dialysis-related pathology, a need for a new strategy is a basic therapeutic option in the armamentorium of exists to improve the overall quality of treatment in the nephrologist: in many instances, it is by necessity end-stage renal failure (ESRF) patients. On-line an alternative to renal transplant. On the other hand, haemodiafiltration (HDF) seems to be the best therait must be remembered that any dialysis modality, peutic option to achieve this goal at the present time. regardless of performance and efficacy, will only parBy enhancing convective clearances through highly tially and periodically restore the composition of the permeable membranes, HDF offers the greatest solute internal milieu of the ESRF patient. Despite such a fluxes both for low and higher molecular weight limitation, RRT is presently supporting the life of uraemic toxins. As for example, in our routinely perabout one million patients worldwide. formed HDF programme based on 3 weekly sessions The success of dialysis as a long-term treatment is lasting 3–4 h each, double-pool urea Kt/V achieved weighted by the increasingly reported incidence of was 1.55±0.20 and b2-microglobulin Kt/V was 0.91. dialysis-specific morbidity. Dialysis-related pathology By producing substitution fluid from fresh dialysate, (DRP), including b2-microglobulin (b2M) amylthe technique of HDF is simplified and becomes ecooidosis, accelerated atherosclerosis, hypertrophic cardinomically affordable. By improving the haemodynamic opathy, aortic stenosis and nutrition, is prevalent after tolerance, HDF allows more elderly and high risk 10 years on RRT. Obviously, DRP marks the boundcardiovascular patients to be treated more safely. By ary limits for long-term RRT by dialysis. Taking a using bicarbonate-buffered infusate, HDF facilitates simplistic approach, one might speculate that DRP has the correction of acidosis. Both by using ultrapure multiple causes belonging to several categories with bicarbonate dialysate and down-regulating the mempossible overlap. These categories can be identified as brane reactivity via a ‘protein cake’, HDF introduces follows: the low overall efficiency of any intermittent the first step for a full haemocompatibility concept. RRT option when compared with native kidneys; the Finally, by giving access to virtually unlimited amounts lack of selectivity in solute removal capacity, with a of sterile and non-pyrogenic fluid, HDF should introparticularly low capacity in removing high molecular duce new therapeutic options such as a totally autoweight substances; the relative shortfall in correcting mated and feed-back-controlled machine. Today’s metabolic abnormalities due to the complexity of the on-line HDF is already a step forward to enhance the internal milieu and the patient–dialysis interaction; overall efficacy of renal replacement therapy and to and the haemobiologic incompatibility of the dialysis improve the global care of ESRF patients. system resulting in the periodic activation of proinflammatory proteins and cell systems.