【摘要】终末期肾病(end stage renal disease，ESRD)是世界范围内重大的公共健康问题。血液透析滤过(hemodiafiltration，HDF)结合了扩散和对流的方法，可有效清除低分子量和中分子量溶质。随着透析膜材料、超滤控制系统和水处理技术的进步，HDF 已成为一项方便、安全、成熟的治疗技术，最新的临床研究结果证实了HDF可能通过更有效的溶质清除和/或低温效应降低ESRD 患者死亡率，改善预后。
【Abstract】End-stage renal disease (ESRD) is a global healthcare burden. Hemodiafiltration (HDF)is capable of effective clearance of solutes of low and middle molecular weight by combining diffusion and convection. With the improvement of dialyzer membrane and the progress of ultrafiltration control system and water treatment techniques, HDF is currently an accessible, safe and well- established treatment option. Latest clinical evidence demonstrated that HDF can reduce mortality of ESRD patients by superior solutes clearance and/or cooling effect.
1. Henderson LW, Colton CK, Ford CA. Kinetics of hemodiafiltration. II. Clinical characterization of a new blood cleansing modality. J Clin Lab Med 1975;85：372-391
2. Leber HW, Wizemann V, Goubeaud G, et al Simultaneous hemofiltration/hemodialysis: an effective alternative to hemofiltration and conventional hemodialysis in the treatment of uremic patients. Clin Nephrol 1978;9：115-121
3. Henderson LW, Beans E: Successful production of sterile, pyrogen-free electrolyte solution by ultrafiltration. Kidney Int 1978; 14: 522–525.
4. Eknoyan G, Beck GJ, Cheung AK, et al. Effect of dialysate dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347:2010–2019
5. Vanholder R, Van Laecke S, Glorieux G. What is new in uremic toxicity? Pediatr Nephrol 2008;23:1211–1221
6. Krieter DH, Hackl A, Rodriguez A, et al. Protein-bound uraemic toxin removal in haemodialysis and post-dilution haemodiafiltration. Nephrol Dial Transplant 2010;25:212–218
7. Basile C, Libutti P, Di Turo AL, et al. Removal of uraemic retention solutes in standard bicarbonate haemodialysis and longhour slow-flow bicarbonate haemodialysis. Nephrol Dial Transplant 2011;26:1296–1303
8. Canaud B, Bragg-Gresham JL, Marshall MR et al. Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS. Kidney Int 2006; 69: 2087–2093
9. Jirka T, Cesare S, Di Benedetto A, et al. Mortality risk for patients receiving hemodiafiltration versus hemodialysis. Kidney Int 2006;70:1523-7.
10. Panichi V, Rizza GM, Paoletti S, et al. Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Results from the RISCAVID study. Nephrol Dial Transplant 2008;23(7):2337-43.
11. Vilar E, Fry AC, Wellsted D, et al. Outcomes in online hemodiafiltration and highflux hemodialysis: a comparative analysis. Clin J Am Soc Nephrol 2009;4(12):1944-53.
12. Grooteman MP, van den Dorpel MA, Bots ML et al. Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol 2012; 23: 1087–1096
13. den Hoedt CH, Grooteman MPC, Bots ML, Blankestijn PJ, et al. The Effect of Online Hemodiafiltration on Infections: Results from the CONvective TRAnsport STudy. PLoS ONE 2015; 10(8): e0135908. https://doi.org/10.1371/journal.pone.0135908
14. Mazairac AH, de Wit GA, Grooteman MP, et al. Effect of Hemodia?ltration on Quality of Life over Time. Clin J Am Soc Nephrol 2013;8: 82–89.
15. Ok E, Asci G, Toz H et al. Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with highflux dialysis: results from the Turkish OL-HDF Study. Nephrol Dial Transplant 2013; 28: 192–202
16. MaduellF,Moreso F,PonsM et al.High-efficiency postdilution online haemodiafiltration reduces all-cause mortality in haemodialysis patients. JAmSoc Nephrol 2013; 24: 487–497
17. Tattersall JE, Ward RA; EUDIAL group. Online haemodiafiltration: definition, dose quantification and safety revisited. Nephrol Dial Transplant 2013;28:542–550
18. Mostovaya IM, Blankestijn PJ, Bots ML et al; on behalf of the EUDIAL Working Group Clinical evidence on hemodiafiltration: a systematic review and a meta-analysis. Semin Dial 2014;27:119–127
19. Peters SAE, Bots ML, Canaud B et al; on behalf of the HDF Pooling Project Investigators Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials. Nephrol Dial Transplant 2016;31: 978–984
20. Canaud BMM, Jausson I, Cristol JP (2004) Clinical tolerance of online HDF and impact on morbidity and cardiovascular risk factors in ESRD patients of 65 and more years old. Project supported by a French National Grant from Health Ministry (PHRC national)
21. Canaud Bernard,Barbieri Carlo,Marcelli Daniele et al. Optimal convection volume for improving patient outcomes in an international incident dialysis cohort treated with online hemodiafiltration.[J] .Kidney Int., 2015, 88: 1108-16.
22. Ronco C. Hemodiafiltration: Technical and Clinical Issues. Blood Purif 2015;40(suppl 1):2-11
23. Wizemann V, Külz M, Techert F, Nederlof B. Efficacy of haemodiafiltration. Nephrol Dial Transplant 2001;16 Suppl 4:27-30.
24. Eguchi Kei,Mineshima Michio,Kamei Daigo et al. Intermittent Infusion Hemodiafiltration: The Principle and Its Clinical Application.[J] .Contrib Nephrol, 2018, 196: 114-118.
25. Farrington Ken,Davenport Andrew,The ESHOL study: hemodiafiltration improves survival-but how?[J] .Kidney Int., 2013, 83: 979-81.
26. Eldehni MT, Odudu A, McIntyre CW. Randomized clinical trial of dialysate cooling and effects on brain white matter. J Am Soc Nephrol 2015;26:957–965
27. Hsu HJ, Yen CH, Hsu KH, et al. Association between cold dialysis and cardiovascular survival in haemodialysis patients. Nephrol Dial Transplant 2012;27:2457–2464
28. Cornelis T, van der Sande FM, Eloot S, et al. Acute hemodynamic response and uremic toxin removal in conventional and extended hemodialysis and hemodiafiltration: a randomized crossover study. Am J Kidney Dis 2014;64:247–25
29. Daugirdas JT. Lower cardiovascular mortality with high volume hemodiafiltration: a cool effect? Nephrol Dial Transplant 2016;31:353–356
