High-Volume Hemofiltration: What Are the Last Indications in 2026? - A Narrative Review.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2026-07-14 DOI:10.1159/000553509

Julien Moury, Sebastien Redant, Willem Boer, Patrick M Honoré

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引用次数: 0

Abstract

Background: High-dose continuous therapies and especially high-volume hemofiltration have failed to demonstrate clinical benefit in septic shock and are, therefore, no longer recommended in this setting. However, extrapolating this negative conclusion to all clinical indications may be inappropriate.

Summary: This narrative review revisits the current and emerging indications for high-dose continuous therapies beyond sepsis, focusing on pathophysiological rationale and toxin kinetics. Recent evidence, notably the CONVINCE trial, has established high-volume intermittent post-dilution online hemodiafiltration as superior to conventional hemodialysis in chronic kidney disease, likely through enhanced removal of middle and protein-bound uremic toxins. In acute settings, high-dose continuous therapy strategies play a critical neuroprotective role in hyperammonemia - both hepatic and non-hepatic - as well as in selected severe drug intoxications, including valproate, metformin, and lithium.

Key messages: When appropriately selected and adequately dosed, high-dose continuous therapies remain powerful, targeted tools in modern blood purification.

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高容量血液滤过：2026年的最后适应症是什么-叙述性回顾。

大剂量持续治疗，特别是大容量血液滤过治疗在感染性休克中未能显示临床益处，因此不再推荐在这种情况下使用。然而，将这一否定结论外推到所有临床适应症可能是不合适的。这篇叙述性综述回顾了目前和新出现的高剂量持续治疗脓毒症的适应症，重点是病理生理原理和毒素动力学。最近的证据，特别是说服试验，已经确定了大容量间歇稀释后在线血液透析优于传统的慢性肾脏疾病血液透析，可能是通过增强去除中间和蛋白质结合的尿毒症毒素。在急性环境下，大剂量连续治疗策略在高氨血症（包括肝脏和非肝脏）以及某些严重药物中毒（包括丙戊酸盐、二甲双胍和锂）中发挥关键的神经保护作用。当适当选择和适当剂量时，大剂量连续治疗仍然是现代血液净化中强有力的、有针对性的工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.