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Review
. 2024 Mar;37(2):331-335.
doi: 10.1007/s40620-023-01768-9. Epub 2023 Oct 16.

ABCs of hemodiafiltration prescription: The Pisa style

Emanuela Mangione  1   2 , Domenico Giannese  1   2 , Adamasco Cupisti  3   4 , Vincenzo Panichi  5   6
Affiliations
Review

ABCs of hemodiafiltration prescription: The Pisa style

Emanuela Mangione et al. J Nephrol. 2024 Mar.

Abstract

In end-stage kidney disease patients, hemodiafiltration, a mixed diffusive-convective technique, has shown beneficial effects in terms of improvement of anemia, inflammation, mineral bone disorders, malnutrition and cardiovascular stability. Greater convective volume exchange was also associated with improved overall and cardiovascular survival. However, absolute target threshold volume would be difficult to define and achieve in daily clinical practice, mainly because of differences in patient size. Convective volumes standardized for body surface area would appear to be the simplest approach in clinical practice. Several factors can affect achievement of optimal convective volume, with vascular access being the main limiting factor. Based on our own clinical experience, hemodiafiltration is a more effective and preferable dialysis technique but only when a target convective volume greater than 20 L can be achieved. Conversely, standard high flux hemodialysis or expanded hemodialysis may be helpful and valuable alternative dialysis techniques.

Keywords: ESKD; HDF; Hemodiafiltration; Standardized convective volume; Tailored dialysis.

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