{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:03:34Z","timestamp":1792692214866,"version":"4.5.0"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Online hemodiafiltration (HDF) is a dialysis modality that can improve patient outcomes beyond those achieved with conventional high-flux hemodialysis (HD) in patients with kidney failure. The CONVINCE trial, the latest and the largest of a series of randomized trials comparing HDF with HD, demonstrated a 23% reduction in the risk of all-cause mortality with high-volume HDF compared to high-flux HD. Systematic reviews of the totality of evidence confirmed cardiovascular and survival benefits of HDF. Further hard-endpoint trials are unlikely to change these findings. The challenge is implementation of these findings in clinical care. Nephrology is used to timeframes of 10\u201315 years before innovation gets implemented at the bedside, and this may well apply to HDF, particularly in regions where structural, regulatory, and financial barriers persist. In this narrative review, we discuss in broad terms the key items of a forward-looking research agenda for HDF after CONVINCE. Key priorities include real-world implementation studies; a strong focus on patient-reported outcomes; mechanistic research to understand why HDF is superior to HD and exploring personalized HDF regimens. Attaining these priorities will require leveraging innovative methods and we discuss two, target trial emulation methods and use of digital twin technologies. We aim to stimulate reflection and enthusiasm toward a modern approach to dialysis research that embraces innovation and centers on patient priorities. We advocate for world-class clinical guidelines on HDF, avoidance of opinion and position statements and a decisive, creative, and innovative research path. Patients with kidney failure deserve care informed by the best available evidence, implemented through rigorous guideline processes and adapted to patient preferences, health-system context, and feasibility.<\/jats:p>","DOI":"10.1093\/ckj\/sfag115","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:39:24Z","timestamp":1776253164000},"source":"Crossref","is-referenced-by-count":2,"title":["Hemodiafiltration beyond the CONVINCE trial"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6936-0616","authenticated-orcid":false,"given":"Giovanni F M","family":"Strippoli","sequence":"first","affiliation":[{"name":"Sydney School of Public Health, The University of Sydney , NSW ,","place":["Australia"]},{"name":"University of Bari Aldo Moro Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), , Bari ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krister","family":"Cromm","sequence":"additional","affiliation":[{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin Center for Patient-Centered Outcomes Research, Department of Psychosomatic Medicine, , Berlin ,","place":["Germany"]},{"name":"Fresenius Medical Care Deutschland GmbH, Global Medical Office , Bad Homburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios C","family":"Pezoulas","sequence":"additional","affiliation":[{"name":"University of Ioannina Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, , Ioannina ,","place":["Greece"]},{"name":"Biomedical Research Institute - FORTH , Ioannina ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Tachos","sequence":"additional","affiliation":[{"name":"University of Ioannina Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, , Ioannina ,","place":["Greece"]},{"name":"Biomedical Research Institute - FORTH , Ioannina ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios I","family":"Fotiadis","sequence":"additional","affiliation":[{"name":"University of Ioannina Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, , Ioannina ,","place":["Greece"]},{"name":"Biomedical Research Institute - FORTH , Ioannina ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Jaure","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, The University of Sydney , NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Malyszko","sequence":"additional","affiliation":[{"name":"Medical University of Warsaw Department of Nephrology, Dialysis and Internal Medicine, , Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Anger","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz School of Medicine , Aurora, CO ,","place":["USA"]},{"name":"Fresenius Medical Care, Global Medical Office , Waltham, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Fischer","sequence":"additional","affiliation":[{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin Center for Patient-Centered Outcomes Research, Department of Psychosomatic Medicine, , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rgen","family":"Hegbrant","sequence":"additional","affiliation":[{"name":"Lund University Division of Nephrology, Department of Clinical Sciences, , Lund ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagar","family":"Nigwekar","sequence":"additional","affiliation":[{"name":"Massachusetts General Brigham Division of Nephrology, Department of Medicine, , Boston, MA ,","place":["USA"]},{"name":"Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00fcmeyza","family":"Kazanc\u0131o\u011flu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, School of Medicine, Bezmialem Vakif University , Istanbul ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"2026060110471706000_bib1","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1093\/ndt\/gfv248","article-title":"Improved survival associated with acetate-free haemodialysis in elderly: a registry-based study","volume":"30","author":"Mercadal","year":"2015","journal-title":"Nephrol Dial Transplant"},{"key":"2026060110471706000_bib2","doi-asserted-by":"publisher","first-page":"2654","DOI":"10.1056\/NEJMoa031643","article-title":"Long-term survival of children with end-stage renal disease","volume":"350","author":"McDonald","year":"2004","journal-title":"N Engl J Med"},{"key":"2026060110471706000_bib3","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1093\/oxfordjournals.ndt.a027963","article-title":"On-line haemodiafiltration versus low-flux haemodialysis: a prospective randomized study","volume":"15","author":"Wizemann","year":"2000","journal-title":"Nephrol Dial Transplant"},{"key":"2026060110471706000_bib4","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1681\/ASN.2011121140","article-title":"CONTRAST Investigators. 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