Development of online hemodiafiltration in Japan
Hideki Kawanishi
Abstract
Abstract Evidence concerning online hemodiafiltration (ol-HDF) includes increased uremic toxin removal, prevention of dialysis-related hypotension, improved survival, and recovery of dialysis-related uncertain symptoms. In particular, evidence has been shown regarding prevention of dialysis hypotension and improvement of survival, but the mechanism of its manifestation is still unclear and its effects themselves are questionable. In Japan, pre dilution ol-HDF is mainly performed, and improvement in survival rate has been shown on the condition of convection volume is 40 L/session or more. In particular, the removal of α 1-microglubulin ( α MG), which is a medium-middle solute, is targeted. The antioxidant action (Heme Scavenger) of α MG, is presumed, but in dialysis patients, the majority in serum are deteriorated (oxidized) α MG. It has been pointed out that removing the deteriorated α MG by ol-HDF may produce new α MG from the liver and lead to recovery of the original antioxidant effect. However, clinical evidence of this mechanism is desired. Obtaining evidence for the indicated α MG removal activity of ol-HDF will lead to advancement in HDF.