Abstract: FR-PO0464
Implementation of Online High-Volume Hemodiafiltration in a Chronic Hemodialysis Center in the United States
Session Information
- Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Spiegel, Steven M., Commonwealth Nephrology Associates, Wellesley, Massachusetts, United States
- Tressler, Danielle, Fresenius Medical Care, Waltham, Massachusetts, United States
- Ficociello, Linda, Renal Research Institute, Waltham, Massachusetts, United States
- Van Zandt, Carly R., Renal Research Institute, Waltham, Massachusetts, United States
- Anger, Michael S., Fresenius Medical Care, Waltham, Massachusetts, United States
- Chatoth, Dinesh K., Fresenius Medical Care, Waltham, Massachusetts, United States
- Usvyat, Len A., Renal Research Institute, Waltham, Massachusetts, United States
- Hippen, Benjamin E., Fresenius Medical Care, Waltham, Massachusetts, United States
- Stuard, Stefano, Fresenius Medical Care, Waltham, Massachusetts, United States
Background
Although high-volume hemodiafiltration (HVHDF) has been widely used outside of the U.S., it has been absent in the U.S. due to previous lack of a dialysis machine able to generate online solutions for HVHDF. With a large clinical trial (CONVINCE, Blankestijn PJ, NEJM 2023) demonstrating a 23% mortality rate reduction in patients undergoing HVHDF compared to high-flux hemodialysis (HD) and confirming real-world evidence (Zhang Y, BMC Neph 2025) there has been interest in utilizing HVHDF in the U.S. This report aims to describe the experience of the first chronic dialysis unit using HVHDF in the U.S.
Methods
Online HVHDF in post-dilution mode was performed using the FDA 510(k) cleared Fresenius Medical Care 5008X Hemodialysis System and Fx CorAl dialyzers. HVHDF is defined by achieving a convection volume (sum of substitution volume (Qsub) and ultrafiltration volume (UFV; change in weight)) ≥ 23 L /session, through automatic optimization using the AutoSub Plus (AS+) feature. Treatments with manual substitution were conducted to gradually increase Qsub prior to patients converting to AS+.
Results
A treatment-level analysis was conducted with 165 completed treatments utilizing AS+ and 64 using a manual Qsub. For treatments with AS+, median tx parameters were convection volume 24.9 L, blood flow rate (Qb) 363 ml/min, dialysate flow rate (Qd) 446 ml/min, treatment time 215 min, UFV 1.30 L and Kt/V 1.76 (Table). Treatments were stratified by convection volume. Compared to treatments not achieving 23 L, treatments achieving ≥ 23 L had higher median Qb, Qd, Qsub, and OLC Kt/V, lower median UFV and UFR, and equivalent median treatment time. Overall, there were 5.7% of treatments with drops in systolic blood pressure < 90 mmHg.
Conclusion
The findings demonstrate that HVHDF can be safely and effectively implemented in a high-throughput U.S. chronic dialysis setting. HVHDF introduction in the U.S. presents an opportunity to enhance dialysis care and potentially improve outcomes, survival and quality of life.
Funding
- Commercial Support – Fresenius Medical Care