University of Jaffna, Department of Medicine, Jaffna, Sri Lanka.
J Bras Nefrol. 2024 Apr-Jun;46(2):e2024PO02. doi: 10.1590/2175-8239-JBN-2024-PO02en.
The desperate attempt to improve mortality, morbidity, quality of life and patient-reported outcomes in patients on hemodialysis has led to multiple attempts to improve the different modes, frequencies, and durations of dialysis sessions in the last few decades. Nothing has been more appealing than the combination of diffusion and convection in the form of hemodiafiltration. Despite the concrete evidence of better clearance of middle weight molecules and better hemodynamic stability, tangible evidence to support the universal adoption is still at a distance. Survival benefits seen in selected groups who are likely to tolerate hemodiafiltration with better vascular access and with lower comorbid burden, need to be extended to real life dialysis patients who are older than the population studied and have significantly higher comorbid burden. Technical demands of initiation hemodiafiltration, the associated costs, and the incremental benefits targeted, along with patient-reported outcomes, need to be explored further before recommending hemodiafiltration as the mode of choice.
为了提高血液透析患者的死亡率、发病率、生活质量和患者报告的结果，在过去几十年中，人们尝试了多种方法来改进不同的透析模式、频率和持续时间。没有什么比以血液透析滤过的形式结合弥散和对流更有吸引力了。尽管有确凿的证据表明中分子量物质的清除率和血液动力学稳定性更好，但仍缺乏支持普遍采用的切实证据。在可能耐受血液透析滤过、血管通路更好且合并症负担较低的选定人群中观察到的生存获益，需要扩展到年龄大于研究人群且合并症负担明显更高的实际透析患者。在推荐血液透析滤过作为首选模式之前，需要进一步探讨血液透析滤过的启动技术要求、相关成本和靶向的增量获益，以及患者报告的结果。
