High convection volume in online post-dilution haemodiafiltration: relevance, safety and costs.

Increasing evidence suggests that treatment with online post-dilution haemodiafiltration (HDF) improves clinical outcome in patients with end-stage kidney disease, if compared with haemodialysis (HD). Although the primary analyses of three large randomized controlled trials (RCTs) showed inconclusive results, post hoc analyses of these and previous observational studies comparing online post-dilution HDF with HD showed that the risk of overall and cardiovascular mortality is lowest in patients who are treated with high-volume HDF. As such, the magnitude of the convection volume seems crucial and can be considered as the 'dose' of HDF.

Optimization of the convection volume in online post-dilution haemodiafiltration: practical and technical issues.

In post-dilution online haemodiafiltration (ol-HDF), a relationship has been demonstrated between the magnitude of the convection volume and survival. However, to achieve high convection volumes (>22 L per session) detailed notion of its determining factors is highly desirable. This manuscript summarizes practical problems and pitfalls that were encountered during the quest for high convection volumes.

Treatment policy rather than patient characteristics determines convection volume in online post-dilution hemodiafiltration.

Background/aims: Sub-analyses of three large trials showed that hemodiafiltration (HDF) patients who achieved the highest convection volumes had the lowest mortality risk. The aims of this study were (1) to identify determinants of convection volume and (2) to assess whether differences exist between patients achieving high and low volumes.

Methods: HDF patients from the CONvective TRAnsport STudy (CONTRAST) with a complete dataset at 6 months (314 out of a total of 358) were included in this post hoc analysis.

Clinical evidence on hemodiafiltration: a systematic review and a meta-analysis.

The general objective assigned to the European DIALysis (EUDIAL) Working Group by the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) was to enhance the quality of dialysis therapies in Europe in the broadest possible sense. Given the increasing interest in convective therapies, the Working Group has started by focusing on hemodiafiltration (HDF) therapies. A EUDIAL consensus conference was held in Paris on 13 October 2011 to discuss definitions, safety standards, clinical outcome and educational issues.

Left ventricular mass in dialysis patients, determinants and relation with outcome. Results from the COnvective TRansport STudy (CONTRAST).

Background And Objectives: Left ventricular mass (LVM) is known to be related to overall and cardiovascular mortality in end stage kidney disease (ESKD) patients. The aims of the present study are 1) to determine whether LVM is associated with mortality and various cardiovascular events and 2) to identify determinants of LVM including biomarkers of inflammation and fibrosis.

Design Setting Participants & Measurements: Analysis was performed with data of 327 ESKD patients, a subset from the CONvective TRAnsport STudy (CONTRAST).

What have we learned from CONTRAST?

The CONvective TRAnsport STudy (CONTRAST) is a large randomized controlled trial which compared on-line postdilution hemodiafiltration and low-flux hemodialysis in terms of mortality and cardiovascular events. This review summarizes and discusses currently available knowledge acquired by CONTRAST, including the main outcome, comparisons of hemodiafiltration to hemodialysis as well as studies performed in subgroups of CONTRAST.