Canaud Bernard, Davenport Andrew
School of Medicine, Montpellier University, Montpellier, France.
Global Medical Office, FMC Deutschland, Bad-Homburg, Germany.
Semin Dial. 2022 Sep;35(5):380-384. doi: 10.1111/sdi.13069. Epub 2022 Mar 18.
On-line hemodiafiltration (ol-HDF) was developed in the 1980s in response to the unmet medical needs observed with conventional low- and high-flux hemodialysis. Firstly, the limited overall efficacy of conventional HD treatment programs as compared to native kidney function has been consistently documented over the broad MW spectrum of uremic toxins as well as fluid volume and hemodynamic control. Secondly, the unphysiological profile of intermittent treatment leading to repetitive dialysis-induced hemodynamic stress is now a well-recognized component of cardiovascular disease and end organ damage. Thirdly, the bioincompatibility of patient-dialysis system leading to dialysis-induced biological reactions also identified as contributing to dialytic morbidity and mortality. To overcome these limitations and pitfalls, alternative convective-based therapies (hemofiltration and hemodiafiltration), using higher hemoincompatible membranes and ultrapure dialysis fluid, were proposed as a solution to enhance and enlarge MW spectrum of uremic compounds cleared and to reduce dialysis-patient biological interactions. In this context, online HDF appeared soon as the best viable and efficient renal replacement modality to cover these needs. Clinical development and implementation of ol-HDF showed also that dialytic convective dose matters with a threshold point (23 L/1.73 m in postdilution mode) to observe clinical benefits and outcomes improvements.
在线血液透析滤过（ol-HDF）于20世纪80年代开发，以应对传统低通量和高通量血液透析中未满足的医疗需求。首先，与天然肾功能相比，传统血液透析治疗方案在尿毒症毒素的广泛分子量范围内以及液体量和血流动力学控制方面的总体疗效有限，这一点已得到持续记录。其次，间歇性治疗的非生理特征导致重复性透析引起的血流动力学应激，现在已被公认为是心血管疾病和终末器官损伤的一个组成部分。第三，患者-透析系统的生物不相容性导致透析引起的生物反应，这也被认为是导致透析发病率和死亡率的原因之一。为了克服这些局限性和缺陷，人们提出了基于对流的替代疗法（血液滤过和血液透析滤过），使用更高生物不相容性的膜和超纯透析液，作为增强和扩大清除的尿毒症化合物分子量范围以及减少透析患者生物相互作用的解决方案。在这种背景下，在线血液透析滤过很快就成为满足这些需求的最佳可行且有效的肾脏替代方式。在线血液透析滤过的临床开发和实施还表明，透析对流剂量很重要，存在一个阈值点（后稀释模式下为23L/1.73m²）以观察临床益处和改善结局。
