Shin Sug-Kyun, Jo Young-Il
Division of Nephrology, Department of Internal Medicine, NHIS Ilsan Hospital, Goyang, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2022 Nov;41(6):670-681. doi: 10.23876/j.krcp.21.268. Epub 2022 Feb 22.
Though noticeable technological advances related to hemodialysis (HD) have been made, unfortunately, the survival rate of dialysis patients has yet to improve significantly. However, recent research findings reveal that online hemodiafiltration (HDF) significantly improves patient survival in comparison to conventional HD. Accordingly, the number of patients receiving online HDF is increasing. Although the mechanism driving the benefit has not yet been fully elucidated, survival advantages are mainly related to the lowering of cardiovascular mortality. High cardiovascular mortality among HD patients is seemingly attributable to the cardiovascular changes that occur in response to renal dysfunction and the HD-induced myocardial stress and injury, and online HDF appears to improve such secondary cardiovascular changes. Interestingly, patient survival improves only if the convection volume is supplied sufficiently over a certain level during online HDF treatment. In other words, survival improvement from online HDF is related to convection volume. Therefore, there is a growing interest in high-volume HDF in terms of improving the survival rate. The survival improvement will require a minimum convection volume of 23 L or more per 4-hour session for postdilution HDF. To obtain an optimal high convection volume in online HDF, several factors, such as the treatment time, blood flow rate, filtration fraction, and dialyzer, need to be considered. High-volume HDF can be performed easily and safely in routine clinical practice. Therefore, when the required equipment is available, performing high-volume HDF will help to improve the survival rate of dialysis patients.
尽管血液透析（HD）技术取得了显著进展，但遗憾的是，透析患者的生存率尚未得到显著提高。然而，最近的研究结果表明，与传统血液透析相比，在线血液透析滤过（HDF）能显著提高患者生存率。因此，接受在线血液透析滤过治疗的患者数量正在增加。尽管其获益机制尚未完全阐明，但生存优势主要与降低心血管死亡率有关。血液透析患者中心血管死亡率较高似乎归因于肾功能不全及血液透析引起的心肌应激和损伤所导致的心血管变化，而在线血液透析滤过似乎可以改善这种继发性心血管变化。有趣的是，只有在线血液透析滤过治疗期间对流总量达到一定水平以上时，患者生存率才会提高。换句话说，在线血液透析滤过带来的生存改善与对流总量有关。因此，就提高生存率而言，大容量血液透析滤过越来越受到关注。对于后置式血液透析滤过，要实现生存改善，每4小时治疗疗程的对流总量至少需要23升或更多。为了在在线血液透析滤过中获得最佳的高对流总量，需要考虑几个因素，如治疗时间、血流量、滤过分数和透析器。在常规临床实践中可以轻松、安全地进行大容量血液透析滤过。因此，当所需设备具备时，进行大容量血液透析滤过将有助于提高透析患者的生存率。
