Medical Board EMEALA, Fresenius Medical Care, Bad Homburg, Germany.
Blood Purif. 2013;35(1-3):55-62. doi: 10.1159/000345175. Epub 2013 Jan 22.
Online hemodiafiltration (OL-HDF), first described in 1985, is today a widely prescribed treatment modality for end-stage chronic kidney disease (CKD) patients. Other than in the United States, prescription of the treatment modality is widespread with a steady increase since its inception. Indeed, in Western Europe, more CKD patients receive OL-HDF than peritoneal dialysis, hitherto the second most prescribed therapy after conventional hemodialysis. The rise and success of OL-HDF can be attributed to diverse clinical advantages that have been documented over the last two decades. Numerous publications attest to the beneficial effects of OL-HDF in terms of removal of a broad spectrum of uremic toxin, anemia control, phosphate reduction, increased hemodynamic stability and blood pressure control and less dialysis-related amyloidosis, to mention just a few. Significantly, the improvement in these conditions is considered to contribute to improved patient outcomes. Despite the extended worldwide clinical experience, elaborate scientific validation of the principles of the therapy and technical innovations that facilitate its prescription, a point of contention is whether OL-HDF leads to a reduction of mortality rates. A number of observational and retrospective analyses have indicated a survival benefit, while prospective investigations involving small numbers of patients but nevertheless specifically addressing survival have further supplied evidence of improved survival with OL-HDF. The quest for large-scale, multicenter prospective randomized controlled trials examining patient survival led to the CONTRAST and the Turkish OL-HDF trials. Both trials have been concluded and published recently. In this chapter, we document and assess the key investigations that have examined the impact of OL-HDF on patient outcome and survival. Based on the findings of previous analyses and of the two recently concluded trials, it appears that the volume of convection appears to be decisive towards the survival benefit accredited to OL-HDF. We consider the implications of this new evidence.
在线血液透析滤过（OL-HDF）于 1985 年首次描述，如今已成为治疗终末期慢性肾脏病（CKD）患者的广泛应用治疗方式。除美国以外，这种治疗方式的处方已广泛应用，且自其问世以来呈稳步增长趋势。实际上，在西欧，接受 OL-HDF 治疗的 CKD 患者多于腹膜透析，腹膜透析是继常规血液透析之后应用第二广泛的治疗方法。OL-HDF 的兴起和成功可归因于过去二十年中记录的多种临床优势。大量出版物证明了 OL-HDF 在清除广泛的尿毒症毒素、控制贫血、降低磷酸盐、提高血液动力学稳定性和血压控制以及减少与透析相关淀粉样变性等方面的有益效果。值得注意的是，这些情况的改善被认为有助于改善患者预后。尽管在全球范围内有广泛的临床经验，但对该治疗的原理和促进其处方的技术创新进行了详细的科学验证，一个争议点是 OL-HDF 是否会降低死亡率。一些观察性和回顾性分析表明存在生存获益，而涉及少数患者但专门针对生存的前瞻性研究进一步提供了证据，表明 OL-HDF 可改善生存。为了进行大规模、多中心的前瞻性随机对照试验以检查患者的生存率，开展了 CONTRAST 和土耳其 OL-HDF 试验。这两项试验均已完成并已发表。在本章中，我们记录并评估了检查 OL-HDF 对患者预后和生存率影响的关键研究。基于之前分析和最近两项已完成试验的结果，似乎对流体积似乎是 OL-HDF 归因于生存获益的决定性因素。我们考虑了这一新证据的意义。
