Characteristics of protein removal in hemodiafiltration.

The on-line HDF system with central supply of the dialysis solution has been developed, which enables us to give more patients HDF treatment at the same time. The high quality infusate was made of dialysis solution by consecutive ultrafiltration with three different filters. The technical notes on assuring accurate infusion rates were also made. From the standpoint of preventing dialysis-related amyloidosis, more aggressive methods to eliminate beta 2-m and larger proteins were described. The RR in the plasma level of beta 2-m was excellent, ranging from 0.75 to 0.84 in all patients. The efficient removal favorably diminishes the overload and the uptake of beta 2-m molecules by inflammatory cells. The aggressive removal of larger proteins is shown to relieve some of the local and systemic inflammatory processes. Taken together, it is possible that the release of amyloidogenic metabolites can be suppressed by proper HDF therapy. The proof of the clinical effectiveness of such a strategy awaits a long-term observation and criticism.