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Haemodiafiltration vs HD CONVINCE — ESENeph MCQ

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ModerateHaemodialysisHaemodiafiltration vs HD CONVINCEESENeph

A 60-year-old woman on haemodialysis is switched from standard HD to online haemodiafiltration (HDF). What is the key advantage of HDF over conventional HD?

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Correct answer: D — HDF provides enhanced clearance of middle molecules (e.g. beta-2 microglobulin) through convective transport, with emerging evidence for improved cardiovascular outcomes

Haemodiafiltration combines diffusive (as in HD) and convective solute removal. Convective clearance is particularly effective for middle molecules (500-60000 Da) such as beta-2 microglobulin, which are poorly cleared by diffusion alone. The CONVINCE trial (2023) showed that high-dose HDF (≥23 L convection volume) significantly reduced all-cause mortality compared to conventional high-flux HD. ERA-EDTA and UKKA now support HDF as a preferred modality where technically feasible. Requirements include high blood flow rates and ultrapure water.

Reference: CONVINCE Trial – NEJM 2023; ERA-EDTA 2023 – HDF Position Statement