Medical Office EMEA, Fresenius Medical Care, Bad Homburg, Germany.
Montpellier University, Montpellier, France.
Nephrol Dial Transplant. 2020 Mar 1;35(3):398-407. doi: 10.1093/ndt/gfz005.
Online haemodiafiltration (HDF) represents today the most advanced and innovative form of renal replacement therapy (RRT). Recent controlled trials tend to prove its superiority over conventional haemodialysis on hard clinical end points provided that the right convective dose was delivered. In this article we report on present prevalent use and epidemiologic trends of HDF worldwide as well as on practice patterns in HDF prescription. In addition we analyze factors that may affect HDF clinical acceptance and more widely its implementation. National and international renal registries provide valuable demographic and epidemiologic information on end stage kidney disease patients on RRT. However, the updating and maintenance of such information system is particularly challenging at a country level and even more so on an international basis. Lag time, incompleteness and/or imprecision of data collection may further hamper precision and validity of data reporting. Fresenius Medical Care (FMC), as a large dialysis care provider operating worldwide, maintains an annually updated database addressing international end stage kidney disease data. Over the last decade, FMC has produced series of precise and reliable reports analyzing RRT trends and practices worldwide. The present overview and analysis is based on our consolidated data from market survey as well as national database registries and databases of recent studies. Online HDF acceptance is growing fast in the two leading regions having approved the method, i.e. Europe and Asia Pacific, with a patient average growth rate of 12 to 24%, being far above the total patient HD growth rate of 6.6%. Today online HDF represents a new paradigm shift in RRT with promising clinical results. Further initiatives (e.g., Kidney Health Initiative, NICE) might provide further push for promoting HDF as a new standard of care in end stage kidney disease patients on a global scale.
在线血液透析滤过（HDF）代表了目前肾脏替代治疗（RRT）中最先进和创新的形式。最近的对照试验倾向于证明，只要给予正确的对流剂量，它在硬性临床终点上优于传统的血液透析。本文报告了目前全球在线 HDF 的流行使用情况和流行病学趋势，以及在线 HDF 处方的实践模式。此外，我们还分析了可能影响 HDF 临床接受度以及更广泛地实施 HDF 的因素。国家和国际肾脏登记处提供了关于接受 RRT 的终末期肾病患者的有价值的人口统计学和流行病学信息。然而，这种信息系统的更新和维护在国家一级，甚至在国际一级都特别具有挑战性。数据收集的延迟、不完整性和/或不准确性可能进一步阻碍数据报告的准确性和有效性。费森尤斯医疗保健（FMC）作为一家在全球范围内运营的大型透析护理提供商，维护着一个每年更新的数据库，用于处理国际终末期肾病数据。在过去的十年中，FMC 已经制作了一系列精确和可靠的报告，分析了全球范围内的 RRT 趋势和实践。本综述和分析基于我们从市场调查、国家数据库登记处以及最近研究的数据库中整合的数据。在已经批准该方法的两个主要地区，即欧洲和亚太地区，在线 HDF 的接受度增长迅速，患者平均增长率为 12%至 24%，远高于总患者 HD 增长率 6.6%。如今，在线 HDF 在 RRT 中代表了一种新的范式转变，具有有前途的临床结果。进一步的倡议（如肾脏健康倡议、NICE）可能会进一步推动在全球范围内将 HDF 作为终末期肾病患者护理的新标准。
