Hemodiafiltration is poised to set a new standard of care for U.S. dialysis. While the technology is becoming a global benchmark, it is not yet the norm for U.S. health care. Nephrologist and Larner Professor of Medicine Thomas Golper, M.D., says in a Healio article, “I do believe hemodiafiltration is better [than hemodialysis]. I have had that bias since 1990.”
Hemodiafiltration combines hemodialysis and hemofiltration using sterile, nonpyrogenic substitution fluid. The procedure combines diffusion and convection to remove middle-molecular weight uremic toxins, whereas standard hemodialysis relies on diffusion alone.
The U.S. approach so far has been measured and historically focused on dialysis efficiency above all, says Golper. Often, that efficiency is determined by dialyzing more patients with short, aggressive sessions on larger surface-area dialyzers, greater extracorporeal blood commitments and higher blood flow rates, according to Golper, who is also emeritus chair of the Healio | Nephrology News & Issues Editorial Advisory Board.
When it comes to using hemodiafiltration more widely in the U.S., cost is a problem. From an economic view, hemodiafiltration brings higher operational costs. New equipment and additional resources are needed. The procedure itself could require longer treatment sessions to achieve convective higher volume goals, leading to an increase in staff labor and total costs.
Golper has a more optimistic perspective, which he explains in a comprehensive review published in Healio in 2024.