Hemodiafiltration (HDF) is an advanced dialysis modality designed to remove a broader range of uremic toxins through a combination of diffusion and convection. When delivered at a high volume (>23L), uremic toxin removal is maximized. High-volume HDF (HVHDF) is associated with significantly lower mortality compared to conventional hemodialysis. Today, HVHDF is supported by decades of peer-reviewed research and is increasingly recognized as a standard of care in many parts of the world.
For more than a century, dedicated medical researchers around the world have studied dialysis and its role in removing uremic toxins from the bloodstream of people living with kidney disease. The first successful dialysis treatment was performed by Willem Kolff of the Netherlands in 1945, marking a pivotal moment in renal care.
In 1967, Dr. Lee Henderson published the first known study on diafiltration, “Blood purification by ultrafiltration and fluid replacement (diafiltration)”, in the journal Transactions of the American Society for Artificial Internal Organs. Since that seminal publication, more than 500 peer-reviewed research papers have explored hemodiafiltration and its clinical applications.
Many of these studies were authored by researchers affiliated with Fresenius Medical Care, reflecting decades of sustained scientific leadership in nephrology. This body of research frequently examines innovations in HVHDF, including dialysis technology, patient outcomes, and clinical practice optimization. More recent publications emphasize real-world evidence, cost-effectiveness, and global implementation strategies.
Global Adoption and Clinical Impact
Since 2004, HVHDF has been adopted as standard therapy in FME NephroCare dialysis centers. From 2014 to 2023, the number of HDF patients worldwide grew by an average of 13% per year, exceeding 500,000 patients worldwide.
Four large randomized controlled trials (RCTs) have demonstrated the superiority of online HDF over HF-HD with respect to clinical outcomes, particularly in reducing the mortality of individuals with end-stage kidney disease (ESKD).
Explore the Research
This page curates a comprehensive collection of peer-reviewed HVHDF publications, including landmark clinical trials and recent innovations. Use the interactive timeline below to explore the evolution of HVHDF research and its growing role in modern dialysis care.
