Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond
Dialysis treatment has improved the survival of patients with kidney failure. However, the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach that significantly impr...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-08-01
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| Series: | Toxins |
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| Online Access: | https://www.mdpi.com/2072-6651/15/9/531 |
| _version_ | 1827723124463894528 |
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| author | Cristian Pedreros-Rosales Aquiles Jara Eduardo Lorca Sergio Mezzano Roberto Pecoits-Filho Patricia Herrera |
| author_facet | Cristian Pedreros-Rosales Aquiles Jara Eduardo Lorca Sergio Mezzano Roberto Pecoits-Filho Patricia Herrera |
| author_sort | Cristian Pedreros-Rosales |
| collection | DOAJ |
| description | Dialysis treatment has improved the survival of patients with kidney failure. However, the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach that significantly improves patient outcomes by effectively eliminating medium and large uremic toxins, which explains its increasing adoption, particularly in Europe and Japan. Interest in this therapy has grown following the findings of the recently published CONVINCE study, as well as the need to understand the mechanisms behind the benefits. This comprehensive review aims to enhance the scientific understanding by explaining the underlying physiological mechanisms that contribute to the positive effects of HDF in terms of short-term benefits, like hemodynamic tolerance and cardiovascular disease. Additionally, it explores the rationale behind the medium-term clinical benefits, including phosphorus removal, the modulation of inflammation and oxidative stress, anemia management, immune response modulation, nutritional effects, the mitigation of bone disorders, neuropathy relief, and amyloidosis reduction. This review also analyzes the impact of HDF on patient-reported outcomes and mortality. Considering the importance of applying personalized uremic toxin removal strategies tailored to the unique needs of each patient, high-volume HDF appears to be the most effective treatment to date for patients with renal failure. This justifies the need to prioritize its application in clinical practice, initially focusing on the groups with the greatest potential benefits and subsequently extending its use to a larger number of patients. |
| first_indexed | 2024-03-10T21:53:57Z |
| format | Article |
| id | doaj.art-c09f0e9306c54f438173a4052c7bdb55 |
| institution | Directory Open Access Journal |
| issn | 2072-6651 |
| language | English |
| last_indexed | 2024-03-10T21:53:57Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Toxins |
| spelling | doaj.art-c09f0e9306c54f438173a4052c7bdb552023-11-19T13:15:38ZengMDPI AGToxins2072-66512023-08-0115953110.3390/toxins15090531Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and BeyondCristian Pedreros-Rosales0Aquiles Jara1Eduardo Lorca2Sergio Mezzano3Roberto Pecoits-Filho4Patricia Herrera5Departamento de Medicina Interna, Facultad de Medicina, Universidad de Concepción, Concepción 4070386, ChileDepartamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8320000, ChileDepartamento de Medicina Interna, Facultad de Medicina, Campus Oriente, Universidad de Chile, Santiago 7500922, ChileInstituto de Medicina, Facultad de Medicina, Universidad Austral, Valdivia 5110566, ChileArbor Research Collaborative for Health, Ann Arbor, MI 48108, USADepartamento de Medicina Interna, Facultad de Medicina, Campus Oriente, Universidad de Chile, Santiago 7500922, ChileDialysis treatment has improved the survival of patients with kidney failure. However, the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach that significantly improves patient outcomes by effectively eliminating medium and large uremic toxins, which explains its increasing adoption, particularly in Europe and Japan. Interest in this therapy has grown following the findings of the recently published CONVINCE study, as well as the need to understand the mechanisms behind the benefits. This comprehensive review aims to enhance the scientific understanding by explaining the underlying physiological mechanisms that contribute to the positive effects of HDF in terms of short-term benefits, like hemodynamic tolerance and cardiovascular disease. Additionally, it explores the rationale behind the medium-term clinical benefits, including phosphorus removal, the modulation of inflammation and oxidative stress, anemia management, immune response modulation, nutritional effects, the mitigation of bone disorders, neuropathy relief, and amyloidosis reduction. This review also analyzes the impact of HDF on patient-reported outcomes and mortality. Considering the importance of applying personalized uremic toxin removal strategies tailored to the unique needs of each patient, high-volume HDF appears to be the most effective treatment to date for patients with renal failure. This justifies the need to prioritize its application in clinical practice, initially focusing on the groups with the greatest potential benefits and subsequently extending its use to a larger number of patients.https://www.mdpi.com/2072-6651/15/9/531hemodiafiltrationkidney failuredialysisuremic toxinshemodynamic tolerancecardiovascular disease |
| spellingShingle | Cristian Pedreros-Rosales Aquiles Jara Eduardo Lorca Sergio Mezzano Roberto Pecoits-Filho Patricia Herrera Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond Toxins hemodiafiltration kidney failure dialysis uremic toxins hemodynamic tolerance cardiovascular disease |
| title | Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond |
| title_full | Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond |
| title_fullStr | Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond |
| title_full_unstemmed | Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond |
| title_short | Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond |
| title_sort | unveiling the clinical benefits of high volume hemodiafiltration optimizing the removal of medium weight uremic toxins and beyond |
| topic | hemodiafiltration kidney failure dialysis uremic toxins hemodynamic tolerance cardiovascular disease |
| url | https://www.mdpi.com/2072-6651/15/9/531 |
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