Clinical effects and treatment outcomes of long-term ol-HDF in adult patients with end stage kidney disease

Hemodiafiltration (ol-HDF) is a proven and recognized blood purification method available for patients with end-stage kidney disease. In this article, we report the clinical and biological effects as well as the long-term outcome of ol-HDF treatment in adult patients with end-stage kidney disease. Description and analysis of intermediary and patient outcomes meet the criteria of evidence-based medicine. They are divided in three main parts: the first part summarizes the specific biological and clinical effects of ol-HDF observed in short-term studies; the second part summarizes the results of long-term clinical studies that have explored the effects on mortality and morbidity; the third part, summarizes the effects of ol-HDF on health-related quality of life and patient experience. ol-HDF remains todate the most effective renal replacement therapy in terms of solute removal on a broad molecular weight spectrum respecting a short dialysis program (4 hours). ol-HDF is associated with beneficial biological and clinical effects such as hemodynamic and overall tolerance, reduction of the inflammatory and oxidative profile, improvement of endothelial dysfunction, facilitation of anemia correction and nutritional preservation. Most recent long-term interventional clinical trials suggest an overall reduction in mortality of approximately 20%, primarily from cardiovascular causes. An optimal convective dialytic dose is necessary to ensure clinical benefits and improved survival. In the current context, it is suggested that a convective dialytic dose or total ultrafiltration volume of 23 liter/1.73m2 per session is the minimum threshold necessary to improve the life expectancy of patients. To this end, it is necessary to ensure and comply with best clinical practices summarized earlier on to achieve the therapeutic objectives. Two large-scale European intervention studies involving a minimal convective dialytic dose are in progress and should help answer the questions that may persist to change renal replacement treatment paradigm. ol-HDF provides already an adequate therapeutic response to the daily problems of ESKD patients and should gain wider acceptance in the future. (C) 2022 Societe francophone de nephrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.