Hemodiafiltration in Acute Kidney Injury

Acute kidney injury (AKI) is one of the most important complications during hospitalization, especially in critically ill patients. Recent data demonstrated that certain biomarkers including pro-inflammatory cytokines are associated with high morbidity and mortality. These biomarkers, most of which have middle molecular weight, and protein-bound uremic toxins are limitedly removed by diffusion mechanism in conventional hemodialysis. Hemodiafiltration (HDF), a new modality that combines convective clearance with diffusion, could effectively enhance removal of middle molecule and protein-bound solutes. Therefore, HDF is increasingly used in several AKI settings such as septic AKI, rhabdomyolysis-associated AKI, myeloma cast nephropathy, and contrast-induced AKI. This chapter summarizes the available HDF techniques including intermittent and continuous modes, and clinical data comprise the benefits of HDF on biomarkers and renal as well as cardiovascular outcomes. Additionally, the topic provides the proposed future directions of HDF in various AKI settings.