Online-hemodiafiltration is defined as a combination of diffusive and convective solute transport using a high-flux membrane with an effective ultrafiltration rate of at least 20% of the blood flow rate in combination with online-generated sterile and nonpyrogenic solution for fluid substution.
Compared with standard conventional hemodialysis, the documented advantages of online-hemodiafiltration include a higher removal rate of higher molecular weight solutes, ß2-microglobulin, and some protein bound-uremic compounds, which may translate into sustained lower serum ß2-microglobulin and phosphat levels. In many but not all study, online-hemodiafiltration was further associated with a lower incidence of intradialytic hypotension, improvements in erythropoetin responsiveness, and nutritional status, as well as prevention of inflammation and better of residual kidney function. These effect may be due to hemodiafiltration itself or secondary to improved dialysate purity and cooling because of high-volume fluid infusion.
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