On-line hemodiafiltration (ol-HDF) may improve clinical outcome in ESRD. The supposed mechanism is the improved clearance of uremic toxins by convective transport which is added to the diffusion transport. However, recent marked improvement in the performance of dialyzers has allowed higher removal rate of middle to large solutes by diffusion. It is inaccurate to define substances with a higher molecular weight such as uremic toxins. In addition, new methods should be developed for the removal of protein-bound substances. A technical fee for on-line HDF was newly established on the revision of the reimbursement for medical services Japan in 2012 and clearly separated from off-line HDF. As a facility requirement, the calculation of ‘addition for maintaining dialysis fluid water quality' was added. Evidence for the clinical effects of ol-HDF have been reported mainly in Europe but is still inaccurate. To confirm the effectiveness of ol-HDF, randomized comparative trials on hemodialysis using super high-flux dialyzers and ol-HDF with same performance hemodiafilter are necessary.

1.
Henderson LW, Sanfelippo ML, Beans E: ‘On-line' preparation of sterile pyrogen-free electrolyte solution. Trans Am Soc Artif Intern Organs 1978;24:465-467.
2.
Asaba H, Bergström J, Fürst P, Lindh K, Mion C, Oulès R, Shaldon S: Sequential ultrafiltration and diffusion as alternative to conventional hemodialysis. Proc Clin Dial Transplant Forum 1976;6:129-135.
3.
Leber HW, Wizemann V, Goubeaud G, Rawer P, Schütterle G: Hemodiafiltration: a new alternative to hemofiltration and conventional hemodialysis. Artif Organs 2 (suppl) 1978;408-411.
4.
Vanholder R, Davenport A, Hannedouche T, Kooman J, Kribben A, Lameire N, Lonne-mann G, Magner P, Mendelssohn D, Saggi SJ, Shaffer RN, Moe SM, Van Biesen W, van der Sande F, Mehrotra R: Reimbursement of dialysis: a comparison of seven countries. J Am Soc Nephrol 2012;23:1291-1298.
5.
Bammens B, Evenepoel P, Verbeke K, Vanrenterghem Y: Removal of the protein-bound solute p-cresol by convective transport: a randomized crossover study. Am J Kidney Dis 2004;44:278-285.
6.
Krieter DH, Hackl A, Rodriguez A, Chenine L, Moragues HL, Lemke HD, Wanner C, Canaud B: Protein-bound uraemic toxin removal in haemodialysis and post-dilution haemodiafiltration. Nephrol Dial Transplant 2010;25:212-218.
7.
Meert N, Eloot S, Schepers E, Lemke HD, Dhondt A, Glorieux G, Van Landschoot M, Waterloos MA, Vanholder R: Comparison of removal capacity of two consecutive generations of high-flux dialysers during different treatment modalities. Nephrol Dial Transplant 2011;26:2624-2630.
8.
Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini LA, Basile C, David S, Feriani M, Montagna G, Di Iorio BR, Memoli B, Cravero R, Battaglia G, Zoccali C: Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD. J Am Soc Nephrol 2010;21:1798-1807.
9.
Grooteman MP, van den Dorpel MA, Bots ML, Penne EL, van der Weerd NC, Mazairac AH, den Hoedt CH, van der Tweel I, Lévesque R, Nubé MJ, Ter Wee PM, Blankestijn PJ: Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol 2012;23:1087-1096.
10.
Ok E, Asci G, Ok ES, Kircelli F, Yilmaz M, Hur E, Demirci MS, Ozdogan O, Demirci C, Sertoz OO, Duman S, Ozkahya M, Kayikcioglu M, Elbi H, Basci A, Toz H: Comparison of postdilution on-line hemodiafiltration and hemodialysis (Turkish HDF study); in EDTA-ERA Congr, Prague, 2011 (LBCT2).
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