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Kusirisin P, Srisawat N. Hemodiafiltration in developing countries. Semin Dial 2022; 35:449-456. [PMID: 35352848 DOI: 10.1111/sdi.13077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
Hemodiafiltration (HDF) is a promising kidney replacement therapy modality for patients with end-stage kidney disease. The principle of uremic toxin clearance by combining convection and diffusion can lead to greater benefits compared to conventional hemodialysis. Evidence is building that supports the advantages of HDF with short-term outcomes such as greater intradialytic hemodynamic stability, improved nutritional status, attenuation of anemia, and reduction of inflammatory cytokines which produce improved key long-term impacts including survival and cardiovascular outcomes. Very little is known about the prevalence of HDF treatments in developing countries due to a shortage of national kidney registries. HDF experience is limited in many countries due to the cost of dialysis treatments, availability of online HDF machines, and reimbursement policies. These obstacles have led to nephrologists developing innovations, for example, convective control HDF (CC-HDF), simple mid-dilution, and simple mixed-dilution methods, which may be as effective as commercially available HDF machines. In this article, we will focus on the experience of HDF practice and barriers to adoption in developing countries. Results can guide clinical practice recommendations for implementing HDF in resource-limited settings.
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Affiliation(s)
- Prit Kusirisin
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Academy of Science, Royal Society of Thailand, Bangkok, Thailand
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