The benefits of High-Volume Online Haemodiafiltration (HDF)


High-Volume Online Haemodiafiltration was lively discussed during a recent Scientific Forum held by Fresenius Medical Care Singapore. The event was supported by the Singapore Society of Nephrology and due to its high scientific quality it has been submitted to the Singapore Medical Council for CME accreditation. Local nephrologists and key opinion leaders reviewed the current study data towards patient outcomes. Read further for an overview of the meeting outcomes.


High-Volume Online HDF combines diffusive and convective transport to increase clearance of middle-to-large sized uremic toxins.1-3 In a scientific CME accredited forum that took place in Singapore on April 10, Dr Feidhlim Woods, a well-known key opinion leader in nephrology and previously Senior Vice President (Medical) of Fresenius Medical Care Asia Pacific, provided an overview to nephrologists on the optimization of patient outcomes through the use of High-Volume Online HDF. The forum was organized by Fresenius Medical Care Singapore and supported by the Singapore Society of Nephrology.

While Online HDF is recognized as being more effective than standard haemodialysis in removing uremic toxins from the blood,1 Dr Woods highlighted that the key question is whether this translates to improved outcomes for patients.

This was recently assessed in the multicenter, open-label, randomized controlled On-Line Haemodiafiltration Survival Study (ESHOL; Estudio de Supervivencia de Hemodiafitracion On-Line).2 Results showed that, compared with patients who continued on standard haemodialysis (n=450), those assigned to Online HDF (n=456) had a:2
  • 30% lower risk of all-cause mortality
  • 33% lower risk of cardiovascular mortality
  • 55% lower risk of infection-related mortality
  • 28% lower risk of intradialytic hypotensive episodes
  • 22% lower risk of all-cause hospitalisation.

Based on these results, the authors concluded that Online HDF may become the first-line option in haemodialysis patients.2

Dr Woods also described the evidence for the use of high-flux versus low-flux haemodialysis. In particular, the prospective, randomized Membrane Permeability Outcome (MPO) study showed that the use of high-flux membranes conferred a significant survival benefit among those with serum albumin levels ≤4 g/dl (p=0.032).3 A post hoc secondary analysis also suggested that high-flux membranes may significantly improve survival in patients with diabetes.3

Dr Woods concluded that there is a sound rationale for removing as many uraemic toxins as possible from the blood of people undergoing dialysis and highlighted that High-Volume OnLine HDF is optimized for solute removal and has been shown to improve patient outcomes.1-3

If you’re interested in receiving the presentation slides, please contact us here.

For more information on Online HDF, please click here or contact Fresenius Medical Care Singapore.


  1. Maduell F, Navarro V, Cruz MC et al. Osteocalcin and myoglobin removal in on-line hemodiafiltration versus low- and high-flux hemodialysis. Am J Kidney Dis 2002;40:582–589.
  2. Maduell F, Moreso F, Pons M. High-Efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 2013;24:487–497.
  3. Locatelli F, Martin-Malo A, Hannedouche T et al; Membrane Permeability Outcome (MPO) Study Group. Effect of membrane permeability on survival of hemodialysis patients. J Am Soc Nephrol 2009;20:645–654.