Fresenius - Transition from Hemodialysis to Hemodiafiltration

Transitioning a patient from HD to HDF requires a properly functioning vascular access, preferably an arteriovenous fistula, and patient-specific stepwise optimization of the dialyzer surface area, blood flow rate, or BFR, needle gauge, and filtration fraction, or FF, to achieve high convection volumes.
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[@kathyjariri2667]

Thank you for the great video ❤

[@osmosis]

Most welcome, Kathy! 😊

[@EduardoGonzalez-fb3jv]

I never knew other methods of hemo- cleaning exist, interesting.
So whats best, hemodialisis or hemodiafiltration???

[@7777fresh]

Good question. I mean more middle molecule clearance with HDF sounds like it would improve outcomes right? Well, in 2016, there was a pooled analysis of the 4 big studies of the time (ESHOL, CONTRAST, THFDS, FRENCHIE), and it did show that online HDF was associated with improved survival with a reduction of all-cause mortality by 14% and a reduction of cardiovascular mortality by 23% compared to HD. But tough to draw that conclusion when the 4 studies were pretty heterogeneous in design and some were post-hoc analyses rather than intention to treat. Recently CONVINCE did report a significant 23% reduction in mortality, but when COVID mortality was excluded from the data set, the significance went away. H4RT trial results are slated to be published in 2025, so I guess we'll see there. Cost effectiveness will also be published soon. Europe is big on HDF from what I understand, but it hasn't quite caught on in America yet.