Haemodiafiltration versus high-flux haemodialysis—a Consensus Statement from the EuDial Working Group of the ERA
A European Renal Association expert panel reviewed all five randomized trials comparing high-volume haemodiafiltration (HDF) with high-flux haemodialysis and concluded that HDF appears to improve overall and cardiovascular survival—but only when high convection volumes are achieved.
Background
Post-filter haemodiafiltration (HDF) and high-flux haemodialysis are the two dominant maintenance dialysis modalities. Whether HDF confers a survival advantage has been debated because the five randomized trials performed to date differ in inclusion criteria and methodology, including informative selection bias and exclusion of poorly-performing patients from HDF arms after randomization.
Study design
The EuDial Working Group of the European Renal Association searched five large databases for parallel or cross-over RCTs comparing HDF with high-flux HD, then used a mini-Delphi method to combine meta-analyses, clinical experience, and expert opinion into 22 consensus points addressing survival, health-related quality of life, and biochemical endpoints, with a dedicated paediatric section.
Key findings
The panel's key summary point is that HDF appears to be associated with improved overall and cardiovascular survival, provided high convection volumes are achieved. Generalizability to the entire dialysis population depends on the patient's overall health and requires further study.
Clinical implications
For dialysis programmes considering HDF, the message is that modality alone is insufficient—delivering adequate convection volume is the operative target. The statement is intended to inform decision-making rather than define a standard of care.
Category
Transplant
Source
Nephrology Dialysis Transplantation
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