{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:23:00Z","timestamp":1791235380430,"version":"4.1.0"},"reference-count":82,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Replacement of kidney function by dialysis maintains the lives of millions of patients. Clinical results however are still unsatisfactory with mortality rates and complications well above the matched control population. This has led to a continuous quest for more effective dialysis techniques and new biomaterials. In the 1980s, the production of synthetic membranes with higher water permeability (\n                      <jats:italic toggle=\"yes\">i.e<\/jats:italic>\n                      ., high flux) leveraged the development of techniques, such as hemodiafiltration (HDF), with improved solute removal, thanks to combination of diffusion and convection. Efficacy trials have demonstrated the superiority of HDF over high-flux hemodialysis for solute removal, hemodynamic tolerance, and survival. Consequently, the technique gained traction in Europe and Asia. In these trials, a minimum target convection volume (\n                      <jats:italic toggle=\"yes\">i.e<\/jats:italic>\n                      ., fluid replaced) of 23 L per session adjusted to body surface area (BSA,\n                      <jats:italic toggle=\"yes\">i.e<\/jats:italic>\n                      ., 23 L multiplied by ratio of individual BSA normalized by 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ) was required to maximize the benefit of the therapy. In general, the replacement fluid is delivered in the postfilter site, and to attain this target of 23 L adjusted to BSA, blood flows must be \u2265350 ml\/min, requiring 14\u201315 Gauge needles or \u226514 French catheters to avoid excessive hemoconcentration and circuit pressure issues. In its early days, the replacement solution was provided with sterile bags (offline), making the therapy costly and cumbersome. Online (OL),\n                      <jats:italic toggle=\"yes\">i.e<\/jats:italic>\n                      ., real-time preparation of ultrapure fluid for replacement, has become the key to reduce cost and complexity, while making the technique (OL-HDF) safe and convenient. In the United States, however, existing regulations and concerns about safety prevented approval for clinical use. In 2024, OL-HDF has received approval by the US Food and Drug Administration in the United States, and this opens new options and perspectives in the management of people living with kidney failure.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000000920","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T17:00:14Z","timestamp":1759770014000},"page":"1061-1073","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["The Role of Online Hemodiafiltration in Contemporary Kidney Care"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6697-4065","authenticated-orcid":false,"given":"Claudio","family":"Ronco","sequence":"first","affiliation":[{"name":"Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy"},{"name":"International Renal Research Institute of Vicenza (IRRIV) Foundation, Vicenza, Italy"},{"name":"Department of Medicine (DIMED), Universit\u00e0 Degli Studi di Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1673-0353","authenticated-orcid":false,"given":"Francisco","family":"Maduell","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Clinic, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8666-0725","authenticated-orcid":false,"given":"Kamyar","family":"Kalantar-Zadeh","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension and Transplantation, Harbor-UCLA Medical Center and the Lundquist Institute, Torrance, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Madero","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Instituto Nacional de Cardiolog\u00eda Ignacio Ch\u00e1vez, Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7071-117X","authenticated-orcid":false,"given":"Thiago","family":"Reis","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of S\u00e3o Paulo Medical School, S\u00e3o Paulo, Brazil"},{"name":"CPQuali Pesquisa Cl\u00ednica, Clinical Research Center, S\u00e3o Paulo, Brazil"},{"name":"Hospital Benefic\u00eancia Portuguesa, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"issue":"4 suppl 1","key":"B1-20260618","doi-asserted-by":"crossref","first-page":"A8","DOI":"10.1053\/j.ajkd.2024.01.001","article-title":"US Renal Data System 2023 annual data report: epidemiology of kidney disease in the United States","volume":"83","author":"Johansen","year":"2024","journal-title":"Am J Kidney 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