Sunday, March 11, 2018

Daily Nocturnal Hemodiafiltration - Yay or Nay?

There’s a lot of buzz these days around Hemodiafiltration (HDF). Various studies have shown that HDF offers better clearances - even of middle molecules, the recovery time is shorter and so on. This results in better outcomes. Ther main principle behind HDF is that the clearance is due to convection rather than diffusion (which is the method by which toxins are cleared in regular HD).

I had been advised to switch to HDF as well by various people. I do daily, nocturnal hemodialysis currently. I dialyze for seven and a half hours, five times a week. After hearing all the buzz, I thought maybe I should also try HDF. Daily nocturnal HDF would be a killer combination - the benefits of longer duration and a higher frequency along with convective clearances that HDF gives.

Or so I thought.

I checked with some experts in the area of more frequent, longer duration dialysis. There was a consensus that for those who do more frequent, longer duration dialysis, there is enough toxin removal. In fact, some stuff was removed so well, phosphate for example, that it had to be supplemented (like for me). The levels of Beta 2 Microglobulin and homocysteine were also normalised. There was also a fear that the things you don’t want removed like amino acids and drugs would be removed. They did not know anyone on this modality. Some also felt that the cost of the treatment would shoot up unnecessarily and water quality monitoring would need to be bettered.

All this put Daily Nocturnal HDF in the “not recommended” category.

Good for me.



But y go for long and frequent durarion hd optiin when u can avail same or better benefit of hdf at shorter and less frequent sessions

Kamal Shah said...

Great question Rajesh. The reasons for this is that water removal is still the same irrespective of HD or HDF. The trouble here is the restricting factor is that the human body can comfortably lose only about 400 ml / hour. So, short, less frequent HDF can never replace long, more frequency HD when it comes to water removal. I will write a more detailed blog post about this.