Kidney Week

Abstract: TH-PO0872

High-Volume Hemodiafiltration in the United States: Real-World Achievement of Target Convective Dose

Session Information

• Dialysis: Prescription, Physiology, and Treatment Optimization
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Ficociello, Linda, Renal Research Institute, New York, New York, United States

Linda Ficociello, PhD

• Van Zandt, Carly R., Renal Research Institute, New York, New York, United States

Carly R. Van Zandt, MS

• Lasky, Rachel A., Renal Research Institute, New York, New York, United States

Rachel A. Lasky, MPH

• Chen, Ming, Renal Research Institute, New York, New York, United States

Ming Chen, PhD

• Anger, Michael S., Fresenius Medical Care, Waltham, Massachusetts, United States

Michael S. Anger, MD, FASN

• Hippen, Benjamin E., Fresenius Medical Care, Waltham, Massachusetts, United States

Benjamin E. Hippen, MD, FASN

• Stuard, Stefano, Fresenius Medical Care, Waltham, Massachusetts, United States

Stefano Stuard, MD, PhD

• Chatoth, Dinesh K., Fresenius Medical Care, Waltham, Massachusetts, United States

Dinesh K. Chatoth, MD, FASN

Background

While many countries outside of the US have extensive experience with high-volume hemodiafiltration (HVHDF), HDF in the US is relatively new. Across randomized clinical trials and real-world clinical experience, delivery of a convection volume (CV) ≥23 L/session is recognized as the target threshold for HVHDF. This is the largest report of achievement of HVHDF in the US to date.

Methods

Hemodiafiltration treatments delivered at Fresenius Kidney Care from October 2025 to April 2026 were assessed for achieving HVHDF with use of AutoSub Plus. AutoSub Plus automatically and safely maximizes substitution flow rates to individualize the substitution volume without additional user interaction. Included in this analysis are treatments of at least 180 minutes duration with valid treatment data. Treatments with an access flow test were excluded. Convection volume is the sum of substitution volume and the net ultrafiltration volume removed. Mean parameters were calculated and stratified by whether at least 23L of CV was achieved. T-tests were used to determine statistical significance.

Results

Over 10,000 treatments from 1,015 patients were assessed, and mean parameters are presented in Table 1. Of these, 74% (7,420/10,042) of treatments achieved at least 23L of CV. Treatments where at least 23L of CV was reached were treated 13 minutes longer with higher blood flow and dialysate flow rates (typically set at 1.2 times the blood flow rate). Additionally, treatments with CV > 23L were from patients with higher body weights, although ultrafiltration volume removed did not differ. The percent of patients with a catheter were similar in each group of treatments. Mean OLC Kt/V was higher in treatments with CV > 23L. Among patients who were followed for 2 weeks to 3 months, 16% (n=159) had all their HDF treatments achieve CV > 23L, and 8% (n=84) had none, however the majority of patients (76%, n=772) had both.

Conclusion

In this largest report of achievement of high-volume HDF in the US, we observed 74% of treatments with CV > 23L. There were few patients (8%) who consistently achieved CV < 23L.

Funding

• Commercial Support – Fresenius Medical Care