In the previous papers, we reported that predilution hemodiafiltration (HDF) has more beneficial effects on dialysis patients than postdilution HDF. The mechanism behind this has not yet been clarified, but some factors could explain the advantage, such as a well-balanced solute removal pattern, reduction in the small nutrient loss and biocompatibility. Generally, the efficacy of small solute and low-molecular-weight protein removal is better in postdilution HDF or hemodialysis than in predilution; however, the more efficient removal does not always lead to the improvement of patients' symptoms and feelings. This issue suggests that the biocompatibility is an essential aspect for evaluating the quality of dialysis modality. There are three possible mechanisms for the advantages of predilution on-line HDF in biocompatibility. First, a large amount of filtrate at the filter could drain away chemical-eluting substances from the dialysis membrane and some reactive proteins. Second, blood dilution could reduce the chance of blood cells to be in close contact with the dialysis membrane surface, and then it could reduce the sequential inflammatory response. Third, blood dilution itself reduces the production of free radicals. We believe the biocompatibility of predilution online HDF is closely related to the improvement of dialysis-related various symptoms.

Keywords:
Nutritional status, Dialysis-related symptom, Polyvinylpyrrolidone, Platelet activation, Radical activity
1.
Masakane I: Selection of dilutional method for on-line HDF, pre- or post-dilution. Blood Purif 2004;22(suppl 2):49-54.
2.
Canaud B, Levesque R, Krieter D, Desmeules S, Chalabi L, Moragues H, Morena M, Cristol JP: On-line hemodiafiltration as routine treatment of end-stage renal failure: why pre- or mixed dilution mode is necessary in on-line hemodiafiltration today? Blood Purif 2004;22(suppl 2):40-48.
3.
Saito A, Suzuki I, Chung TG, Okamoto T, Hotta T: Separation of an inhibitor of ery-thropoiesis in ‘middle molecules' from hemodialysate from patients with chronic renal failure. Clin Chem 1986;32:1938-1941.
4.
Yamada S, Kataoka H, Kobayashi H, Ono T, Minakuchi J, Kawano Y: Identification of erythropoietic inhibitor from the dialysate collected in the hemodialysis with PMMA membrane (BK-F) and its clinical effects; in Ronco C (ed): Polymethylmethacrylate. A Flexible Membrane for a Tailored Dialysis. Contrib Nephrol. Basel, Karger, 1998, vol 125, pp 159-172.
5.
Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, Berglund L, Jogestrand T: Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999;55:1899-1911.
6.
Masakane I: High-quality dialysis: a lesson from the Japanese experience. Nephrol Dial Transplant Plus 2010;3(suppl 1):i28-i35.
7.
Masakane I: Choice of modality with the use of high-performance membrane and evaluation for clinical effects; in Saito A, Kawanishi H, Yamashita AC, Mineshima M (eds): High-Performance Membrane Dialyzers. Contrib Nephrol. Basel, Karger, 2011, vol 173, pp 84-94.
8.
Kobayashi S, Miyamoto M, Kurumatani H, Oka M, Maesato K, Mano T, Ikee R, Moriya H, Ohtake T: Increased leukocyte aggregates are associated with atherosclerosis in patients with hemodialysis. Hemodial Int 2009;13:286-292.
9.
Gritters-van den Oever M, Grooteman MP, Bartels PC, Blankestijn PJ, Bots ML, van den Dorpel MA, Schoorl M, Ter Wee PM, Nube MJ: Post-dilution haemodiafiltration and low-flux haemodialysis have dissimilar effects on platelets: a side study of CONTRAST. Nephrol Dial Transplant 2009;24:3461-3468.
10.
Tomo T, Matsuyama K, Nasu M: Effect of hemodiafiltration against radical stress in the course of blood purification. Blood Purif 2004;22(suppl 2):72-77.
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2013
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