Haemodiafiltration versus high-flux haemodialysis—a Consensus Statement from the EuDial Working Group of the ERA

Haemodialysis (HD) is a life-saving therapy for individuals with kidney failure. Post-filter haemodiafiltration (HDF) and high-flux HD are the most widely used treatment modalities. To date, five randomized controlled trials (RCTs) have been performed that compare all-cause and cardiovascular (CV) mortality between HDF and low- or high-flux HD in adults receiving maintenance dialysis for at least 1 year. RCTs, meta-analyses and pooled individual patient data analyses have been published on this topic. However, all of them are limited by the heterogeneity of inclusion criteria and significant methodological shortcomings, including informative selection bias and the exclusion of poorly performing patients from the HDF arm after randomization. Given this background, the European Dialysis Working Group of the European Renal Association presents a Consensus Statement on HDF and high-flux HD, addressing three key outcomes: survival, health-related quality of life, and biochemical endpoints. A separate section is dedicated to paediatric patients. We searched five large electronic databases to identify parallel or cross-over RCTs comparing HDF with high-flux HD on pre-defined outcome measures. Using a mini-Delphi method, we developed 22 key consensus points by combining meta-analyses, clinical experience, and expert opinion. They aim to inform and assist in decision making and are not intended to define a standard of care. The key summary point is that HDF appears to be associated with improved overall and CV survival, provided high convection volumes are achieved. The generalizability of these findings to the entire dialysis population depends on the patient's overall health and requires further study.

Authors

Institutions

Publication Details

Journal
Nephrology Dialysis Transplantation
Published
2025-02-06
DOI
https://doi.org/10.1093/ndt/gfaf024
Citations
16
Primary Topic
Dialysis and Renal Disease Management
Type
article
Field-Weighted Citation Impact
22.89
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Haemodiafiltration versus high-flux haemodialysis—a Consensus Statement from the EuDial Working Group of the ERA

Christian Combe, Vassilios Liakopoulos, Björn Meijers, Yuri Battaglia et al.
16 citations
Nephrology Dialysis Transplantation
Dialysis and Renal Disease Management
22.89
article

Haemodiafiltration versus high-flux haemodialysis—a Consensus Statement from the EuDial Working Group of the ERA

Christian Combe, Vassilios Liakopoulos, Björn Meijers, Yuri Battaglia, Rukshana Shroff, Federica Baciga, Alessandro Mantovani, Ionuţ Nistor, Adrian Covic, Peter J. Blankestijn, Casper F. M. Franssen, Carlo Basile, Gaetano Alfano, Valérie A. Luyckx, Claudia Momentè, Federica Caccia, Andrew Davenport
article en
16 citations

Abstract

Haemodialysis (HD) is a life-saving therapy for individuals with kidney failure. Post-filter haemodiafiltration (HDF) and high-flux HD are the most widely used treatment modalities. To date, five randomized controlled trials (RCTs) have been performed that compare all-cause and cardiovascular (CV) mortality between HDF and low- or high-flux HD in adults receiving maintenance dialysis for at least 1 year. RCTs, meta-analyses and pooled individual patient data analyses have been published on this topic. However, all of them are limited by the heterogeneity of inclusion criteria and significant methodological shortcomings, including informative selection bias and the exclusion of poorly performing patients from the HDF arm after randomization. Given this background, the European Dialysis Working Group of the European Renal Association presents a Consensus Statement on HDF and high-flux HD, addressing three key outcomes: survival, health-related quality of life, and biochemical endpoints. A separate section is dedicated to paediatric patients. We searched five large electronic databases to identify parallel or cross-over RCTs comparing HDF with high-flux HD on pre-defined outcome measures. Using a mini-Delphi method, we developed 22 key consensus points by combining meta-analyses, clinical experience, and expert opinion. They aim to inform and assist in decision making and are not intended to define a standard of care. The key summary point is that HDF appears to be associated with improved overall and CV survival, provided high convection volumes are achieved. The generalizability of these findings to the entire dialysis population depends on the patient's overall health and requires further study.

Nephrology Dialysis TransplantationVol. 40(8)
University of Verona (IT), University of Modena and Reggio Emilia (IT), Brigham and Women's Hospital (US), University Medical Center Groningen (NL), Harvard University (US), Université de Bordeaux (FR), University of Cape Town (ZA), University of Groningen (NL), Utrecht University (NL), University of Zurich (CH), Aristotle University of Thessaloniki (GR), Great Ormond Street Hospital (GB), AHEPA University Hospital (GR), The Royal Free Hospital (GB), Prevention Institute (US), Centre Hospitalier Universitaire de Bordeaux (FR), University Medical Center Utrecht (NL), Grigore T. Popa University of Medicine and Pharmacy (RO), Azienda Ospedaliera Universitaria Integrata Verona (IT), Bordeaux Population Health (FR), Casa di Cura Villa Garda (IT), University College London (GB), KU Leuven (BE)
Openalex Percentile: Top 0%
Dialysis and Renal Disease Management
22.89
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.