Optimizing renal replacement therapy--a case for online filtration therapies?

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Abstract
Ideally, renal replacement therapies (RRT) would mimic the function of the normal kidney. However, this goal is not approached both by the discontinuous nature of the treatment and by the fact that the clearance characteristics of the artificial kidney do not even approximate those of the normal human kidney. Haemodialysis and, to a somewhat lesser degree, peritoneal dialysis, which mainly operate by diffusion, preferably remove small molecules but do not remove a large amount of larger molecules that are normally cleared by the kidney. In contrast, haemofiltration (HF) and haemodiafiltration (HDF) are treatment modalities that, due to their convective nature, more closely approach the function of the normal kidney [1]. However, after a burst of initial attention, enthusiasm for these techniques declined during the 1980s, probably because of economic motives due to the high costs of the pharmaceutically prepared substitution fluid and, in the case of HF, because of the limited removal of small molecules.

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