This book has many fathers and mothers. Together, they represent countless decades of clinical experience in the use of hemodiafiltration (HDF) for treating patients with end-stage kidney disease. United by a shared commitment to advancing care, the contributors aim to offer physicians and, more broadly, the entire clinical team, a practical, evidence-based guide to post-dilution high-volume hemodiafiltration (HVHDF).

I would like to express my heartfelt gratitude to all the authors for their invaluable insights, inspiring contributions, and collegial collaboration throughout the creation of this work.

My sincere thanks also go to my colleagues at Fresenius Medical Care—in the Global Medical Office, Care Delivery, and Care Enablement—whose thoughtful feedback, expert guidance, and unwavering support significantly enhanced the scientific quality of this book. I am especially grateful for their patience and the many constructive, professional, and insightful suggestions they generously shared during the intense finalization period.

I also wish to acknowledge and thank the pioneers at Fresenius Medical Care who had the vision to recognize that hemodiafiltration has the potential to transform dialysis care, by improving both clinical outcomes and quality of life for tens of thousands of patients around the world.

A special note of appreciation goes to Ms. Jeannine Sohayda, whose cheerful dedication and tireless support were instrumental in organizing the final manuscript. Her efficiency, attention to detail, and positive spirit were deeply appreciated.

Dedication

I dedicate this book to Mr. Benito Lucantonio*, who, in 2009, after the earthquake that devastated my city of L’Aquila (Italy) and destroyed the city public hospital, taught me an unforgettable lesson about resilience, dignity, and the true meaning of healing.

In the midst of chaos, as we established a temporary dialysis center inside a tent, he came to me with a simple but powerful request: to continue his hemodiafiltration therapy, even under those emergency conditions. He spoke with quiet conviction, telling me how much better he felt since starting HDF. His insistence was not a complaint—it was an expression of trust in a therapy that had restored his strength.

There, in that tent, as he received his treatment with gratitude and composure, I came to understand—not only clinically, but deeply and personally—the real value of hemodiafiltration. From that moment on, I knew this therapy was not only scientifically sound but also profoundly human.

To Mr. Lucantonio, with gratitude. You inspired this journey.

Stefano Stuard

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* Mr. Lucantonio is currently living with a stable and well-functioning kidney transplant.