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    HighVolumeHDF®

    HighVolumeHDF®

    Do it for your patients                              

    See what our patients, Joanna from Singapore and Mr. Tsai from Taiwan, have to say about their experience with HighVolumeHDF therapy.

    "For (taking) HighVolumeHDF, I feel much stronger….
    Having my grandson is a great joy to me and that’s a motivation for me also. I have to carry on, I have to make myself better, and I can play with him more."

    - Joanna

    "On the doctor’s suggestion, I adopted the new therapy (HighVolumeHDF). I’ve undergone dialysis for almost 30 years. Physically I am well able for my job, and have never been hospitalized for my kidney problem."

    - Mr Tsai

    A history of commitment to HDF

    1983: 2008C

    1983: 2008C “Conventional HDF with solution bags"

    c1988: A2008 Online HDF

    1988: A2008 Online HDF

    1998: 4008H ONLINEplus®

    1998: 4008H ONLINEplus® “Advanced ONLINEplus technology as optional module”

    2005: 5008 Therapy System

    2005: 5008 Therapy System “Online hemodiafiltration as standard treatment mode“

    2012: 5008 & 5008S

    2012: 5008 & 5008S “With AutoSub plus HighVolumeHDF® becomes as simple and reliable as HD”

    2013

    2013

    From hemodiafiltration to HighVolumeHDF®

    HDF is a renal replacement technique combining two principles – diffusion and convection. The convective process is based on the ultrafiltration of large amounts of plasma water across the membrane. This allows for the effective removal of larger solutes due to convection in addition to the diffusive transport of small molecules.

    To maintain the fluid balance it is necessary to replace the additional ultrafiltration volume, ideally after the dialyzer, the so-called post-dilution HDF.

    Volume matters in hemodiafiltration

    Recent publications have demonstrated that a large convective volume in post-dilution mode is required in order to maximize the benefits of HDF therapy.8, 9,11-15  

    According to the Catalonian high-volume HDF study a substitution volume (without allowing for weight loss) of at least 21 L per treatment in post-dilution mode should be the target to derive the survival benefit.8

    The production of large amounts of substitution volume is no longer a challenge. Today maximizing substitution volume for each patient requires a new therapeutic approach – HighVolumeHDF®.

    Benefits

    Therapy advantages

    Graph of weekly clearances
    Internal data: schematic graph of weekly clearances

    HighVolumeHDF® with its numerous positive effects on cardiovascular risk factors in dialysis patients is acknowledged as the most effective dialysis treatment modality1, coming closer to the elimination profile of the natural kidney. By achieving high substitution volumes, HighVolumeHDF® therapy is credited with more effective elimination of middle molecules. HighVolumeHDF® improves patient outcomes and exerts beneficial effects on the potential cardiovascular risk factors related to dialysis patients:
     

    • Serum ß2-m and phosphate level2,3,4
    • Inflammatory response5
    • Intradialytic haemodynamic stability6
    • Anaemia control9 

    These factors possibly contribute to improved patient survival.8

    Reduced mortality risk with HighVolumeHDF®

    In recent years several studies have confirmed the clinical benefits of HDF.8,9,11,12 These studies have demonstrated that large convection volumes in post-dilution mode are required in order to achieve and maximize the benefits of HDF therapy. The Catalonian high-volume HDF study shows a significant 30% risk reduction in all-cause mortality for patients with high-efficiency postdilution online HDF compared to HD8. The inverse relation between the magnitude of convection volume and mortality risk has been reinforced by the European Dialysis Working Group in their latest meta-analysis13 and was confirmed by the HDF Pooling Project investigators.14 The analysis showed that HDF reduces the risk of all-cause and cardiovascular mortality, especially with convection volumes of at least 23 L/session.14

    HighVolumeHDF® — most advanced and still cost-efficient

    It is not only the possible reduction of overall treatment cost which makes HighVolumeHDF® with the 5008 CorDiax attractive, but it is also its eco-friendliness and the associated financial savings due to an effective and sustainable use of resources.

    Best use of resources with the CorDiax product line

    Diagram of dialysate flow
    Internal data: Post-dilution with FX CorDiax 600 Hct = 35%; Recirculation = 5%

    The innovative and highly automated features support nursing staff by optimizing daily workflows and ensuring high and consistent levels of patient safety. The result is an easy integration of HighVolumeHDF® in the daily routine. The preparation of sterile, non-pyrogenic substitution fluid for HighVolumeHDF® is based on a double-stage filtration process.

    • No extra costs for an additional single-use filter
    • No need for ready-made rinse solutions or waste bag for priming or reinfusion

    The AutoFlow feature automatically adapts the dialysate flow to the blood flow. This generates substantial savings in water, waste water, concentrates and energy, and results in considerable cost reductions.

    HighVolumeHDF® – lower overall treatment costs

    Diagram of cost-saving potential of HighVolumeHDF®
    Cost-saving potential of HighVolumeHDF®   * Valid for patients on Sevelamer only

    The main drivers for dialysis-related treatment costs are, in addition to direct procedure costs, hospitalization, and erythropoietin (EPO) and phosphate binder usage. In an economically-tight environment every opportunity to reduce the overall treatment cost should be examined. A high hospitalization rate does not only impacting the patients' quality of life but is the most expensive form of medical care in every healthcare system. HighVolumeHDF® has the potential to significantly reduce hospitalization rates and hypotensive episodes.8 The amount of EPO1 and phosphate binders4, 10 administered to dialysis patients has been shown to be reduced with the application of HDF. Thus, higher quality of care can be provided at a lower medication burden and medication cost.

     

     

    Study

    The Catalonian high-volume HDF study8

    The Catalonian high-volume HDF study data confirm our original conviction that every patient should get the chance to benefit from HighVolumeHDF®.

    Improved Survival

    Catalonian high-volume HDF study data
    *Median delivered convective volume ranged from 23 to 24L/session **92% on High-Flux HD Graph adapted from original publication
    30% risk reduction in all-cause mortality (p=0.01)
    55% risk reduction in mortality from infection (p=0.03) 
    61% risk reduction in mortality from stroke (p=0.03)

    Compared with patients maintained on conventional high-flux hemodialysis, those randomized to high-efficiency postdilution online hemodiafiltration had a significantly lower all-cause mortality.

    Better patients‘ well-being

    28% Risk reduction in incidence of hypotensive episodes (p<0.001)

    Reduced treatment costs

    22% Risk reduction in all-cause hospitalization (p=0.001)

    Study details8

    Study aim:
    To compare the impact of online hemodiafiltration over hemodialysis on patient survival.

    Study design:
    Multi-center, prospective randomized controlled trial promoted by the Catalonian Society of Nephrology.

    Study endpoints:
    The primary outcome variable was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerance and laboratory data.

    Patients:
    906 chronic hemodialysis patients were assigned either to continue hemodialysis (n=450) or to be switched to high-efficiency postdilution online hemodiafiltration (n=456).  

    Get the study details

    Products

    HighVolumeHDF® is Fresenius Medical Care

    HighVolumeHDF® image

    The challenges of hemodiafiltration have led us to continuously develop new innovative products, which support the HighVolumeHDF® therapy approach. Our long standing commitment to making HighVolumeHDF® available to all patients has resulted in an advanced and highly synergetic portfolio. The result: The 5008 and 5008S in combination with the FX CorDiax HDF hemodiafilter and the Online Purification Cascade (OPC) today form an integrated therapy system, enhanced by services tailored to support your therapy.

    5008 and 5008S: HighVolumeHDF® as standard

    5008 and the 5008S

    With the new AutoSubplus function of the 5008 CorDiax and the 5008S CorDiax, HighVolumeHDF® has become as simple and reliable as HD without any need for additional user interaction.

    FX CorDiax Hemodiafilters: Superior by design

    FX CorDiax hemodiafilters are designed for optimal flow conditions assuring effective middle molecule removal while avoiding albumin loss.

    Online Purification Cascade (OPC): Intelligent water quality management

    Online Purification Cascade (OPC) product line

    The OPC product line covers all processes for the delivery of the large amounts of substitution fluids required for HighVolumeHDF® therapy.

    Related Content

    5008 & 5008S
    5008 & 5008S

    HighVolumeHDF® as standard.

    FX CorDiax dialyzer
    FX CorDiax dialyzer

    Designed to Dialyze. Built for Cardioprotection.

    1 Krick G, Ronco C (eds), Contributions to Nephrology (2011); 175: 93-109.

    2 Canaud B., Contributions to Nephrology (2007); 158: 216-224.

    3 Penne L. et al., Clinical Journal of the American Society of Nephrology (2010); 5: 80-86.

    4 Davenport A., Nephrology Dialysis Transplantationt (2010); 25: 897-901.

    5 Pedrini L. et al., Nephrology Dialysis Transplantation (2011); 26: 2617-2624.

    6 Locatelli F. et al., Journal of the American Society of Nephrology (2010); 21: 1798-1807.

    7 Bonforte G. et al., Blood Purification (2002); 20: 357-363.

    8 Maduell F. et al., Journal of the American Society of Nephrology (2013); 24: 487-497.

    9 Ok E., et al., Nephrology Dialysis Transplantation (2013); 28: 192-202.

    10 Pedrini, L. et al., Nephrology Dialysis Transplantation  (2011); 26: 2617-2624.

    11 Grooteman M.P. et al., Journal of the American Society of Nephrolog (2012); 23(6): 1087-96.

    12 Canaud B. et al., Kidney International (2006); 69(11): 2087-93

    13 Mostovaya I.M. et al., Seminars in Dialysis (2014); 27(2): 119-127.

    14 Peters S.A.E. et al., Nephrology Dialysis Transplantation (2016); 31: 978-984.

    15 Basile C. et al., Journal of Nephrology (2017); 30(2): 181-186.

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