The Triad of Special Techniques in Hemodialysis: OL-HDF, HDx, HAHD (PDF)

by Claudio Ronco, Gonzalo Ramírez-Guerrero, Maria Gabriela Guimarães, Thiago Reis

The present book is a collection of original manuscripts describing the rationale, the mechanisms and the clinical application of special dialysis techniques such as On-Line Hemodiafiltration (OL-HDF), Expanded Hemodialysis (HDx) and Hemoadsorption combined with Hemodialysis (HAHD): what we call today the ‘triad of special treatments of uremia’. These extracorporeal techniques represent a new frontier in the area of extracorporeal blood purification for patients with end stage kidney disease (kidney failure), having demonstrated clinical results definitely superior to classic dialysis techniques. In patients on maintenance dialysis, mortality rates are still high and comorbidities are significantly reducing quality of life. Outcomes are far from being satisfactory. This has been ascribed to the limited capacity of current dialysis techniques to restore homeostasis and to provide adequate removal of large middle molecules and protein bound uremic toxins. New options are offered by the triad of special treatments by: 1) optimization of convective transport (OL-HDF), 2) Optimization of membrane permeability and internal filtration (HDx), 3) Adjunctive capacity of removal of large middle molecules and protein-bound toxins by coupling sorbents to current techniques (Hemoadsorption/hemodialysis – HAHD). The book is focused on these three techniques, their rationale, their clinical indications and their impact on outcomes, without seeking superiority of one technique over the other but rather emphasizing the advantages of each treatment strategy. The personal experience of the outstanding key opinion leaders authoring the various chapters will offer the reader a clear spectrum of therapeutic options to improve outcomes in a true patient-centered approach.