This review provides a detailed analysis of hemodiafiltration (HDF), its progress from an emerging technique to a potential conventional treatment for chronic hemodialysis patients, and its current status. The article covers advances, methodologies, and clinical benefits of HDF, spe-cifically focusing on its impact on cardiovascular health, survival rates, and overall well-being. The text also addresses concerns about the safety of HDF and provides evidence to dispel worries re-lated to the elimination of beneficial substances and infection risks. Additionally, the article ex-plores the potential implications of expanded hemodialysis (HDx) as an alternative to HDF, its classification, safety profile, and an ongoing trial assessing its non-inferiority to HDF. Supported by evidence from randomized controlled trials and observational studies, the review emphasizes the superiority of HDF as a hemodialysis modality, advocating for its positioning as the gold standard in treatment. However, it acknowledges the need for extensive research to define the role of HDx in comprehensive treatment approaches for individuals undergoing dialysis. The synthesis of current knowledge underscores the importance of ongoing exploration and research to refine hemodialysis practices for optimal patient outcomes.

There are several forms of maintenance high-efficiency hemodialysis (HD) including hemodiafiltrations (HDF) in different technic modes and expanded HD using dialyzers with medium cut-off membranes. The aim of the study was to assess the intradialytic tolerance and length of dialysis recovery time (DRT) in these modalities. This is an exploratory, cross-over study in maintenance HD patients with low comorbidity and no clinical indications for the use of high-efficiency HD, who were exposed to five intermittent dialysis in random order: high flux hemodialysis (S-HD), expanded HD (HDx), pre-dilution HDF (PRE-HDF), mix-dilution HDF (MIX-HDF) and post-dilution HDF (POST-HDF). 24 dialysis sessions of each method were included in the analysis. Dialysis parameters including blood flow rate, dialysis fluid flow rate and temperature, and pharmacological treatment were constant. Average total convection volume for post-HDF, pre-HDF and mix-HDF were 25.6 (3.8), 61.5 (7.2) and 47.1 (11.4) l, respectively. During all therapies, patients had similar hydration status monitored using bioimpedance spectroscopy and similar variability over time in systemic blood pressure, cardiac output, and peripheral resistance monitored using impedance cardiography. The lowest frequency of all intradialytic adverse events were observed during HDx. Delayed DRT was the shortest during PRE-HDF. Patients were also more likely to report immediate recovery while receiving PRE-HDF. These differences did not reach statistical significance, however the study results suggest that, intradialytic tolerance and DRT may depend on the dialysis method used. This support the need of taking into account patient preferences and quality of life while individualizing high efficiency therapy in HD patients.