Akizawa Tadao, Koiwa Fumihiko
Blood Purif. 2015;40 Suppl 1:12-6. doi: 10.1159/000437405. Epub 2015 Sep 8.
Many pieces of evidence of online hemodiafiltration (HDF) have been reported, and the clinical advantage of postdilution online HDF with sufficient substitution is now established. After the approval of online HDF in 2012, the number of online HDF patients has been dramatically increasing in Japan and reached 10% of the total dialysis population at the end of 2013. One of the marked characteristics of Japanese online HDF is a widespread use of predilution treatment and, in 2013, 90.8% of online HDFs were carried out with the predilution mode. The main reason for the wide use of predilution online HDF results from the low blood flow rate in Japan, by which it is difficult to substitute a sufficient volume during the limited treatment time. Other reasons to choose the predilution mode include the reduction of albumin loss and the suppression of membrane fouling during treatment. Contrary to postdilution treatment, adequate clinical evidence has not been reported for predilution online HDF to provide a better outcome of the patients. A further clinical trial is expected to elucidate the clinical advantages over conventional hemodialysis for predilution online HDF.
已有许多关于在线血液透析滤过（HDF）的证据报道，目前已证实充分置换的后置稀释在线HDF具有临床优势。2012年在线HDF获批后，日本接受在线HDF治疗的患者数量急剧增加，到2013年底已达到透析总人数的10%。日本在线HDF的一个显著特点是预稀释治疗的广泛应用，2013年，90.8%的在线HDF采用预稀释模式。预稀释在线HDF广泛应用的主要原因是日本的血流速度较低，在有限的治疗时间内难以置换足够的液体量。选择预稀释模式的其他原因包括减少白蛋白损失以及抑制治疗过程中的膜污染。与后置稀释治疗相反，尚无充分的临床证据表明预稀释在线HDF能为患者带来更好的治疗效果。期待进一步的临床试验能阐明预稀释在线HDF相对于传统血液透析的临床优势。
