Current state of hemodialysis and hemodiafiltration. Review

More than 850 million people worldwide suffer from various kidney diseases that are potentially irreversible and lead to end-stage kidney failure and disability. As before, the main method of treatment is to replace the lost kidney function with specialized methods of treatment: hemodialysis, peritoneal dialysis, hemodiafiltration and kidney transplantation. The number of available donor kidney transplants remains low. So dialysis remains the main method of treating kidney failure. About 80% of patients with the end-stage renal failure are treated with chronic programmed hemodialysis. The review briefly presents the history of the development of methods of extrarenal (extracorporeal) purification of the body's blood, the evolution of technical equipment and methodologies, and the change in ideas about existing methods as the evidence base accumulates. The article discusses the indications and contraindications of various methods of treatment of kidney failure. A comparative analysis is given and the path of development of various dialysis techniques is traced (low-flow intermittent hemodialysis, high-flow intermittent hemodialysis, extended/long-term intermittent hemodialysis, intermittent/extended hemodiafiltration). Currently, the most effective method of dialysis is hemodiafiltration as a result of a combination of diffusive and convective transport of solutes through the hemofilter membrane. The review considers the advantages of the hemodiafiltration method for hemodialysis (better elimination of uremic toxins, the effect on the blood lipid spectrum, better control of anemia, reduced doses of rEPO, better biocompatibility and hemodynamic stability, reduction of inflammation and oxidative stress products), a review of previously existing and recently conducted large randomized studies. Hemodiafiltration is considered to be the most effective method of dialysis associated with better patient survival. Modern criteria (international standards) for online hemodiafiltration (HDF OL) are evaluated. The article discusses the factors limiting the use of HDF OL in clinical practice. The latest data on the development and results of the first clinical studies of the use of extended dialysis using membranes with a "mid-cut-off point" is presented. The possibility of using extended dialysis as an alternative to HDF OL is discussed.

гемодиализ, гемодиафильтрация, конвекционный объем, инфузионный объем, исходы лечения, hemodialysis, hemodiafiltration, convection volume, infusion volume, treatment outcomes

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