Hemofiltration Redux (original) (raw)

Blood Purification, 1999

Abstract

The Journal of the American Society of Nephrology recently presented a publication by Henderson, Colton and Ford from 1975 as a Milestone in Nephrology [1]. The title is ‘Kinetics of hemodiafiltration. II. Clinical characterisation of a new blood cleansing modality’. Rereading this classical paper was like seeing an old photograph of a close friend. All the well-known features are there, although he looks quite different today. Hemofiltration (HF), as the name was later changed to, is characterised by convective solute removal which is independent of molecular weight. Already in the first clinical application [1], the investigators could show increased removal of medium-to-large solutes, reduction of symptoms connected with fluid removal and improved blood pressure control with time, all in comparison with hemodialysis (HD). The importance of the sieving properties of the membrane to allow removal of solutes up to the size of, but not including, albumin was noted. Finally, the authors pointed to what was to become the Achilles’ heel of hemofiltration therapy – the cost and the labor connected with using large volumes of replacement fluid. In the commentaries to this milestone publication, Henderson and Bosch emphasise the great technical contributions to present dialysis therapy that were spin-offs from hemofiltration projects in the late 1970s and 1980s – high-flux membranes, volume control and ultrafiltration to prepare pyrogen-free fluids. These are today essential components of renal replacement therapies, without which we could not perform high-flux dialysis, hemodiafiltration, various forms of CRRT or use ultrapure fluids in hemodialysis. Considering this it may be felt that hemofiltration therapy should be allowed to rest in peace. The epitaph could be that it contributed greatly to present dialysis technology, but did not qualify as a renal replacement therapy. However, there are still nephrologists who are convinced that the clinical benefits of hemofiltration are unequalled by present dialysis therapies, and that many of the clinical problems encountered in today’s dialysis population would be ideally managed by hemofiltration.

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