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Cochrane Library: Hemodiafiltration for end-stage kidney disease

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Cochrane Library: Hemodiafiltration for end-stage kidney disease (updated evidence summary)



End-stage kidney disease causes accumulation of metabolites and excess fluid. Renal replacement therapy including hemodialysis is used to remove unwanted solutes and fluid retention but is incompletely effective at restoring full health. Dialysis patients experience a heavy burden of symptoms including fatigue, itch, depression, sleep disturbance, and appetite loss. In addition, 10-20% of dialysis patients die each year.

Hemodialysis eliminates solutes by diffusion across the dialysis membrane. Diffusion in the movement of solutes down a concentration gradient from high to low concentration. However, diffusion fails to remove metabolites of larger molecular weight (such as beta-2-macroglobulin) due to their slow diffusion capacity. High levels of ‘middle molecules’ are associated with poorer patient outcomes including infection and mortality.

Hemodiafiltration is a hybrid dialysis technology that uses diffusion and convection to remove solutes and water. In convection, positive pressure pushes water across the dialysis membrane. Solutes cross the membrane with the water movement in a phenomenon known as ‘solvent drag’. Hemodiafiltration is more effective than hemodialysis at removing larger circulating molecules and is associated with improved survival in non-randomized studies.

This updated Cochrane review directly compared convective dialysis technologies (hemofiltration and hemodiafiltration) with hemodialysis for treatment of end-stage kidney disease to explore the effects of hemodiafiltration on patient outcomes.



Ionut Nistor

Ionut is a nephrologist based at the "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania. He has worked as an Honorary Research Fellow at Cochrane Kidney and Transplant and joined European Renal Best Practice (ERBP) in August 2011 as an ERBP fellow in the Methods Team.


Suetonia Palmer

Suetonia is a nephrologist based at the University of Otago, Christchurch in New Zealand, and who trained in New Zealand and the USA. She is an Editor for Cochrane Kidney and Transplant.


Copyright© 2016 Cochrane Kidney and Transplant. Published by John Wiley & Sons, Ltd.

Additional Info

  • Language: English
  • Contains Audio: No
  • Content Type: eLearning modules
  • Source: Cochrane
  • Year: 2016
  • Members Only: No
Read 5582 times Last modified on Monday, 19 September 2016 10:52

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