Maduell Francisco
Blood Purif. 2015;40 Suppl 1:17-23. doi: 10.1159/000437409. Epub 2015 Sep 8.
Retrospective randomized clinical studies have shown that online hemodiafiltration (OL-HDF) is associated with a lower risk reduction of mortality than standard hemodialysis.
In all of these large randomized studies, the convective volume seemed to be an important issue, but the optimal OL-HDF dose has not yet been defined. This article, to make a EUDIAL working group position, reviews the association between survival and convective volume, the minimum recommended replacement volume, the importance of the infusion flow rate, and the main limiting factors in achieving a high convective volume. Finally, the article discusses whether the convective dose should be normalized to body size. Key Messages: At present, there is sufficient scientific evidence to indicate that OL-HDF treatment reduces mortality risk and that it should be the first-line option in hemodialysis patients. It seems reasonable to recommend that patients should receive the highest possible convective dose and that the largest possible blood flow should be used to obtain the highest possible infusion flow rate. Based on the results of secondary analyses of the main clinical trials, the current recommendation of the optimal dose of OL-HDF, in the postdilutional mode and on a thrice-weekly treatment schedule, would be a convective volume higher than 23 liters/session. There is insufficient scientific evidence to recommend that the convective dose should be normalized to body size.
回顾性随机临床研究表明，在线血液透析滤过（OL-HDF）与降低死亡率的风险低于标准血液透析。
在所有这些大型随机研究中，对流体积似乎是一个重要问题，但最佳的OL-HDF剂量尚未确定。本文为了形成欧洲透析与移植协会（EUDIAL）工作组的立场，回顾了生存率与对流体积之间的关联、推荐的最低置换量、输注流速的重要性以及实现高对流体积的主要限制因素。最后，本文讨论了对流剂量是否应根据体重进行标准化。关键信息：目前，有充分的科学证据表明OL-HDF治疗可降低死亡风险，且应成为血液透析患者的一线选择。建议患者应接受尽可能高的对流剂量，并应使用尽可能大的血流量以获得尽可能高的输注流速，这似乎是合理的。根据主要临床试验的二次分析结果，目前对于OL-HDF在后置稀释模式下每周三次治疗方案的最佳剂量建议是，对流体积高于23升/每次治疗。没有足够的科学证据推荐对流剂量应根据体重进行标准化。
