On-line hemodiafiltration. Gold standard or top therapy?
In summary, on-line HDF is an extracorporeal blood purification therapy with increased convective removal of uremic toxins as compared to the most frequently used low- or high-flux HD therapy. The clinical advantages of on-line HDF have shown to be dose dependent, which makes on-line HDF superior to other therapies with less convective solute removal. Among the therapies with high convective solute removal, i.e. on-line HDF, on-line HF and double high-flux dialysis, it is difficult to finally decide on the best therapy, as direct comparisons of these therapies are not performed. Theoretical considerations like the relative to on-line HDF lower achievable Kt/Vurea with on-line HF, allow to state that on-line HDF is the top therapy now available for patients with ESRD. A gold standard may be defined as something with which everything else is compared if one tries to establish it in the respective field. In order to declare on-line HDF as the gold standard in renal replacement therapy, we need more direct comparisons of on-line HDF with other therapies, including mortality as an outcome parameter. However, based on our current knowledge, it does not seem to be too speculative that high-quality clinical studies will establish on-line HDF in the next years as the new gold standard in renal replacement therapy.
Passlick-Deetjen
Jutta
J
Fresenius Medical Care Deutschland GmbH Medicine & Marketing, Else-Kröner-Str. 1, D-61352 Bad Homburg, Germany.
Pohlmeier
Robert
R
D005112:Extracorporeal Circulation; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D006801:Humans; D009862:Online Systems; D011785:Quality Assurance, Health Care; D006435:Renal Dialysis; D012449:Safety