Research in brief: Implementation of online high-volume hemodiafiltration

A growing body of evidence suggests improved patient outcomes with hemodiafiltration (HDF) over high‑flux hemodialysis for people who have chronic kidney disease. In this Research in Brief, Steven Spiegel, MD, points to this substantial and expanding body of research, including the recent CONVINCE study, which reported a 23% reduction in all‑cause mortality among patients treated with HDF. Beyond survival benefits, real‑world experience suggests that patients may also experience improved post‑treatment recovery times.

In 2025, Fresenius Medical Care received FDA clearance in the U.S. for the 5008X CAREsystem, enabling the online generation of substitution fluid required for high-volume HDF (HVHDF) treatments. HVHDF is defined as achieving greater than or equal to 23 liters of convective volume using post dilution hemodiafiltration.

In the first seven months of 2025, clinicians conducted 165 treatments using the system’s Auto Sub Plus feature and 64 treatments with manual substitution rates, with the program expanding rapidly thereafter. The U.S. implementation of online HVHDF demonstrates that high-volume convective dialysis therapies can be safely integrated into routine clinical practice, expanding access to treatment approaches associated with improved survival. Read more about these results here: Implementation of online high-volume hemodiafiltration in a chronic hemodialysis center in the United States

The successful integration of HVHDF into U.S. dialysis centers represents more than a technical milestone — it signals a meaningful opportunity to elevate the standard of dialysis care and potentially improve outcomes, survival, and quality of life.

Watch the video below: