{"id":7863,"date":"2025-07-23T01:19:58","date_gmt":"2025-07-23T06:19:58","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&#038;p=7863"},"modified":"2025-08-26T14:22:09","modified_gmt":"2025-08-26T19:22:09","slug":"chapter-9-strategy-to-prioritize-patient-selection-for-the-implementation-of-hvhdf","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/chapter-9-strategy-to-prioritize-patient-selection-for-the-implementation-of-hvhdf\/","title":{"rendered":"Chapter 9 | Strategy to prioritize patient selection for the implementation of HVHDF"},"content":{"rendered":"<p>To date, there are no known or documented contraindications for HDF. Therefore, in principle, all dialysis patients could benefit from the advantages of HVHDF. To implement HVHDF effectively in a clinic where all patients are currently receiving high-flux HD, the following prioritization rules are recommended:<\/p>\n<h2>9.1\u00a0 | Eligibility Criteria<\/h2>\n<p>Before considering the switch from high-flux dialysis to post-dilution HVHDF, it is suggested to evaluate if patients meet the following baseline requirements:<\/p>\n<ul>\n<li>Blood flow rate \u2265 330 ml\/min. A well-functioning AVF is preferred. Patients with CVCs or AVGs may be considered if they can achieve Qb &gt; 330 ml\/min.<\/li>\n<li>Treatment time \u2265 210 minutes\/session.<\/li>\n<li>Anticoagulants: Preventing clotting within the extracorporeal circuit is mandatory to optimize HDF efficacy and ensure patient safety.<\/li>\n<li>Normal blood viscosity: Patients with high blood viscosity (e.g., polycythemia, high blood concentration of fibrinogen and lipids) are at higher risk of fiber clogging.<\/li>\n<\/ul>\n<h2>9.2\u00a0 | Prioritization Based on Clinical Benefit<\/h2>\n<p>Once eligibility is confirmed, prioritize patients based on the potential benefits of HVHDF:<\/p>\n<ol style=\"list-style-type: upper-alpha;\">\n<li><strong>High Priority<\/strong>\n<ol>\n<li>Patients capable of achieving high convection volumes \u2265 23 L\/session.<\/li>\n<li>Patients on active kidney transplantation list.<\/li>\n<li>Patients with hemodynamic instability.<\/li>\n<li>Patients with heart failure, coronary artery disease.<\/li>\n<li>Patients with high ultrafiltration needs requiring substantial fluid removal.<\/li>\n<li>Patients with large body size.<\/li>\n<\/ol>\n<\/li>\n<li><strong>Moderate Priority<\/strong>\n<ol>\n<li>Patients with residual kidney function. Those maintaining urine output &gt;1000 mL\/24 hours may experience improved toxin clearance with HVHDF.<\/li>\n<li>Patients with elevated serum phosphorus levels.<\/li>\n<li>Patients with dialysis-related amyloidosis.<\/li>\n<li>Patients with worsening nutritional status.<\/li>\n<li>Patients with polyneuropathy.<\/li>\n<li>Patients with itching.<\/li>\n<\/ol>\n<\/li>\n<li><strong>Lower Priority<\/strong>\n<ol>\n<li>Patients with limited vascular access. Individuals with CVCs or AVGs that cannot achieve high Qbs may not realize the full benefits of HVHDF.<\/li>\n<li>Patients with shorter session durations. Those unable to undergo 4-hour sessions may not achieve the necessary convection volumes for optimal HVHDF efficacy.<\/li>\n<li>Patients who are not compliant with the dialysis procedure and accompanying prescriptions, mainly the frequency and duration of dialysis treatment, should have lower priority.<\/li>\n<li>Patients with life expectancy of less than 3 months.<\/li>\n<li>Patients intolerant of heparin or anticoagulants.<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<h2>9.3\u00a0 | Implementation Considerations<\/h2>\n<ul>\n<li>Gradual transition: Begin with high-priority patients, monitoring their response closely before expanding to other groups.<\/li>\n<li>Monitor convection volumes: To maximize HVHDF benefits, aim for a target convection volume of &gt; 23 liters per session.<\/li>\n<li>Patient education: Inform patients about the potential advantages and any risks associated with HVHDF to ensure informed decision-making.<\/li>\n<li>Resource assessment: Ensure the availability of necessary equipment and trained staff to support HVHDF therapy.<\/li>\n<li>By adhering to these criteria, clinics can effectively identify and prioritize patients who are most likely to benefit from transitioning to HVHDF, thereby optimizing clinical outcomes and resource utilization.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[5],"tags":[296],"language":[41],"articles":[162],"class_list":["post-7863","article","type-article","status-publish","format-standard","hentry","category-articles","tag-handbook-hdf","language-english","articles-hemodiafiltration","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Chapter 9 | Strategy to prioritize patient selection for the implementation of HVHDF - Advanced Renal Education Program<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/chapter-9-strategy-to-prioritize-patient-selection-for-the-implementation-of-hvhdf\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chapter 9 | Strategy to prioritize patient selection for the implementation of HVHDF - Advanced Renal Education Program\" \/>\n<meta property=\"og:description\" content=\"To date, there are no known or documented contraindications for HDF. 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