Convective dialysis therapies, current status and perspective.
When introduced in the 1970s, convective dialysis therapies were considered an attractive alternative to hemodialysis (HD), but technical and economical limitations prevented wide clinical application. Today, these therapies (i.e. hemofiltration and hemodiafiltration) are receiving renewed interest from the renal community. The main reason is the disappointment with current chronic dialysis therapy, which despite continuous integration of technical and pharmaceutical progress, has not provided significantly improved survival. The recent HEMO study showed that HD, even when administered at high dose and with high-flux membranes, has reached the limit of benefit for a representative dialysis population. At the same time there is new evidence supporting convective therapies. The extended range of solutes that is removed by convection as opposed to diffusion includes many molecules associated with uremic symptoms and complications. The hemodynamic stability characteristic of convective therapies is confirmed also in comparison with modern HD. Observational data indicates a survival benefit for patients treated with large volumes of convection. Continuously applied convective therapies are the preferred choice in severe cases of acute renal failure, and new membrane development may take these therapies to new applications of blood purification in the intensive care unit.
Ledebo
Ingrid
I
Gambro Corporate Research, Lund, Sweden. ingrid.ledebo@gambro.com
D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy; D017583:Hemodiafiltration; D006440:Hemofiltration / Q000379:methods* / Q000639:trends; D006801:Humans; D016896:Treatment Outcome; D014511:Uremia / Q000097:blood / Q000628:therapy