Hemofiltration: An Unnecessarily Complex Method to Achieve Hypotonic Sodium Removal and Controlled Ultrafiltration

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Abstract
High flux hemofiltration (HF) has been routinely reported to result in decreased morbidity compared to hemodialysis (HD). Examination of Na and water transport in these comparative studies indicates: (1) HF with substitution fluid sodium concentration 140 mEq/l results in hypotonic ultrafiltration over the normal range of plasma sodium: (2) the error in ultrafiltration with state of the art HD is 6 times greater than for HF and results in a 6-fold increase in Na balance error; (3) the majority of clinical studies comparing HF and HD have not been designed to achieve equal Na flux; (4) hypotonic Na removal and improved ultrafiltration control may be major determinants of decreased morbidity with HF.

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