There are two types of hemodiafiltration (HDF) treatments, predilution and postdilution. In Japan, clinical doctors have been using the on-line HDF treatment for renal replacement therapy for 20 years. However, this treatment is not popular in Japan because it has not been recognized by the government. Generally, the advantage of postdilution HDF over predilution HDF resides in the fact that it removes low-weight molecular proteins (LWMPs) and protein-binding uremic toxin. Thus, postdilution on-line HDF has been widely used in the world, but in Japan predilution on line-HDF has been the preferred treatment. There are several reasons why predilution on-line HDF has been the preferred treatment in Japan. Predilution on-line HDF is superior to postdilution on-line HDF in removing LWMPs and protein-binding uremic toxin, for example p-cresol and homocysteine. In addition, there are several reports on the biocompatibilities in predilution on-line HDF. Predilution on-line HDF is associated with reduced shear stress, and the synthesis of cytokine and cellular adhesion molecules. Moreover, with predilution on-line HDF/hemofiltration, blood pressure remains stable during treatment. In Japan, over 90% of dialysis patients have been receiving hemodialysis (HD) therapy with the ultra-high flux dialysis membrane. These ultra-high flux dialysis membranes achieve β2-microglobulin clearance rates of >50 ml/min. In addition, these membranes have the same power as postdilution HDF because they allow automatic internal filtration. Thus, in spite of HD treatment, as a result, the effect is the same as with postdilution HDF treatment. There have been small and retrospective studies on predilution on-line HDF, and we must use a hemodiafilter during the on-line HDF treatment. However, the hemodiafilter has been unsuccessful in reaching the LWMP removal rates which we demand. And the most important point is to carry out a prospective multicenter randomized controlled trial of predilution on-line HDF in the near future.

Keywords:
Predilution on-line hemodiafiltration, Albumin leakage, Separation abilities, α1-Microglobulin, Cytokine, Shear stress, Intradialytic hypotension, ZEBRA pattern
1.
Nakai S, Iseki K, Itami N, Ogata S, Kazama JJ, Kimata N, Shigematsu T, Shinoda T, Shoji T, Suzuki K, Taniguchi M, Tsuchida K, Nakamoto H, Nishi H, Hashimoto S, Hasegawa T, Hanafusa N, Hamano T, Fujii N, Masakane I, Marubayashi S, Morita O, Yamagata K, Wakai K, Wada A, Watanabe Y, Tsubakihara Y: Overview of regular dialysis treatment in Japan (as of 31 December 2009). Ther Apher Dial 2012;16:11-53.
2.
Tsuchida K, Minakuchi J: Effect of large-size dialysis membrane and hemofiltration/hemodiafiltration methods on long-term dialysis patients; in Kawanishi H, Yamashita AC (eds): Hemodiafiltration - A New Era. Contrib Nephrol. Basel, Karger, 2011, vol 168, pp 179-187.
3.
Nakamura M, et al: The influence of plasma cytokine on pre and post dilution HDF (in Japanese). Kidney Dial (HPM) 2007;63:103-107.
4.
Nakai S, Iseki K, Tabei K, Kubo K, Masakane I, Fushimi K, Kikuchi K, Shinzato T, Sanaka T, Akiba T: Outcomes of hemodiafiltration based on Japanese dialysis patient registry. Am J Kidney Dis 2001;38:S212-S216.
5.
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.
6.
Suzuki K: Examination about the nourishment by the high dose on-line HDF. 55th JSDT, 2010. http://enjinkai.com/society/22.6.18%E7%B7%8F%E4%BC%9A.pdf#search='HDF%20栄養%20鈴木'.
7.
Matsuyama K, Tomo T, Kadota J: Acetate-free blood purification can impact improved nutritional status in hemodialysis patients. J Artif Organs 2011;14:112-119.
8.
Masakane I: How to prescribe hemodialysis or hemodiafiltration in order to ameliorate dialysis-related symptoms and complication; in Kawanishi H, Yamashita AC (eds): Hemodiafiltration- A New Era. Contrib Nephrol. Basel, Karger, 2011, vol 168, pp 53-63.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.