{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T11:46:50Z","timestamp":1767613610580,"version":"3.48.0"},"reference-count":27,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T00:00:00Z","timestamp":1767484800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background and Objectives: On-line hemodiafiltration (OL-HDF) has been proposed as an alternative to conventional hemodialysis (HD) for patients with end-stage chronic kidney disease (CKD). Randomized controlled trials suggest that OL-HDF may reduce mortality, particularly when the convection volume (CV) exceeds 23 L\/1.73 m2 per session. However, achieving this target depends on local practices and may be limited to selected populations. The CONVINCE trial reported a 97% success rate using a structured optimization protocol, but its applicability to unselected real-world populations remains uncertain. This study aimed to evaluate the incidence of high CV in OL-HDF among unselected patients managed under routine conditions with a standardized optimization protocol. Methods and Materials: This prospective cohort study (May\u2013October 2024) included 67 unselected incident and prevalent patients undergoing HD or HDF in a hospital-based dialysis center. All patients were switched to post-dilution OL-HDF following the CONVINCE optimization protocol, which involved stepwise increases in blood flow, adjustment of filtration fraction, and optimization of session duration. Results: The mean age was 68.8 \u00b1 14.9 years; 56.7% were male. Blood flow increased from 283 to 338 mL\/min (p &lt; 0.001), and the use of dialyzers &gt; 2 m2 increased from 36% to 68% (p &lt; 0.003). Kt\/V improved from 1.22 to 1.6 (p &lt; 0.01). CV increased by ~2 L from M1 onward and was sustained through M6, correlating positively with blood flow, session duration, and Kt\/V (all p &lt; 0.01). Conclusions: Stepwise optimization protocol enabled sustained achievement of high CV (23.5 L\/session) in 62.3% of patients, improving dialysis adequacy.<\/jats:p>","DOI":"10.3390\/diseases14010020","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T10:03:48Z","timestamp":1767607428000},"page":"20","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimization of the Convective Dose in On-Line Hemodiafiltration: Prospective Interventional Cohort Study\u2014Conducted at Soissons Hospital, France"],"prefix":"10.3390","volume":"14","author":[{"given":"Bedel","family":"Lukoki-Beudin","sequence":"first","affiliation":[{"name":"Nephrology Department, Soissons General Hospital, 02200 Soissons, France"},{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tchilabalo","family":"Kakomkate","sequence":"additional","affiliation":[{"name":"Nephrology Department, Soissons General Hospital, 02200 Soissons, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wahiba","family":"Ibeghouchene","sequence":"additional","affiliation":[{"name":"Nephrology Department, Soissons General Hospital, 02200 Soissons, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9line","family":"Carreira","sequence":"additional","affiliation":[{"name":"Nephrology Department, Soissons General Hospital, 02200 Soissons, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imene","family":"Ouertani","sequence":"additional","affiliation":[{"name":"Nephrology Department, Soissons General Hospital, 02200 Soissons, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6639-5648","authenticated-orcid":false,"given":"Bruce Shinga","family":"Wembulua","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Goma, Goma P.O. Box 03, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannick Mayamba","family":"Nlandu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannick Mompango","family":"Engole","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-France Mboliasa","family":"Ingole","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augustin Luzayadio","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francois Musungayi","family":"Kajingulu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Robert Rissassy","family":"Makulo","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Bonny","family":"Nsumbu","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vieux Momeme","family":"Mokoli","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazaire Mangani","family":"Nseka","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernest Kiswaya","family":"Sumaili","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1031-2326","authenticated-orcid":false,"given":"John","family":"Bukasa-Kakamba","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadrian Hoang-Vu","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Palisades Medical Center, Hackensack, NJ 07601, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey","family":"Thu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Touro College of Osteopathic Medicine, New York, NY 10940, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayrton","family":"Bangolo","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, John Theurer Cancer, Hackensack University Medical Center, Hackensack, NJ 07601, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izage Kianifar","family":"Aguilar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Palisades Medical Center, Hackensack, NJ 07601, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simcha","family":"Weissman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Palisades Medical Center, Hackensack, NJ 07601, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janette","family":"Mansour","sequence":"additional","affiliation":[{"name":"Nephrology Department, Soissons General Hospital, 02200 Soissons, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine Busanga","family":"Bukabau","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Division of Internal Medicine, University Clinics of Kinshasa, University of Kinshasa, Kinshasa P.O. Box 1333, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,4]]},"reference":[{"key":"ref_1","unstructured":"GBD Chronic Kidney Disease Collaboration (2020). Global, regional, and national burden of chronic kidney disease, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 395, 709\u2013733."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"sfad240","DOI":"10.1093\/ckj\/sfad240","article-title":"Twenty years of the French Renal Epidemiology and Information Network","volume":"17","author":"Kazes","year":"2024","journal-title":"Clin. Kidney J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"sfae117","DOI":"10.1093\/ckj\/sfae117","article-title":"Prevalence of chronic kidney disease in France: Methodological considerations and pitfalls with the use of Health claims databases","volume":"17","author":"Couchoud","year":"2024","journal-title":"Clin. Kidney J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1093\/ndt\/gfac165","article-title":"Increasing numbers and improved overall survival of patients on kidney replacement therapy over the last decade in Europe: An ERA Registry study","volume":"38","author":"Huijben","year":"2023","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e007525","DOI":"10.1136\/bmjgh-2021-007525","article-title":"Prevalence of chronic kidney disease in Asia: A systematic review and analysis","volume":"7","author":"Liyanage","year":"2022","journal-title":"BMJ Glob. Health"},{"key":"ref_6","first-page":"e5018","article-title":"Kidney health for all in sub-Saharan Africa: Challenges and prospects","volume":"16","author":"Sumaili","year":"2022","journal-title":"Ann. Afr. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kaze, A.D., Ilori, T., Jaar, B.G., and Echouffo-Tcheugui, J.B. (2018). Burden of chronic kidney disease on the African continent: A systematic review and meta-analysis. BMC Nephrol., 19.","DOI":"10.1186\/s12882-018-0930-5"},{"key":"ref_8","first-page":"346","article-title":"Chronic renal failure in C\u00f4te d\u2019Ivoire: A study of 800 hospitalised cases","volume":"90","author":"Diallo","year":"1997","journal-title":"Bull. Soc. Pathol. Exot."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1016\/S2214-109X(16)00071-1","article-title":"Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): A cross-sectional study","volume":"4","author":"Perico","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e174","DOI":"10.1016\/S2214-109X(14)70002-6","article-title":"The epidemiology of chronic kidney disease in sub-Saharan Africa: Systematic review and meta-analysis","volume":"2","author":"Stanifer","year":"2014","journal-title":"Lancet Glob. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.nephro.2010.03.008","article-title":"Epidemiology of chronic kidney disease in the Democratic Republic of Congo: A review of cross-sectional studies from Kinshasa, the capital","volume":"6","author":"Sumaili","year":"2010","journal-title":"Nephrol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1093\/ndt\/gfv349","article-title":"Haemodiafiltration and mortality in patients with end-stage renal disease: Analysis of pooled individual data from four randomised controlled trials","volume":"31","author":"Peters","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1056\/NEJMoa021583","article-title":"Effect of dialysis dose and membrane flux in maintenance hemodialysis","volume":"347","author":"Eknoyan","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1681\/ASN.2008060590","article-title":"Effect of membrane permeability on survival in hemodialysis patients","volume":"20","author":"Locatelli","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_15","first-page":"8","article-title":"Hemodiafiltration-optimal efficacy and safety","volume":"3","author":"Ledebo","year":"2010","journal-title":"NDT Plus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1681\/ASN.2011121140","article-title":"Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes","volume":"23","author":"Grooteman","year":"2012","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1056\/NEJMoa2304820","article-title":"Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure","volume":"389","author":"Blankestijn","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.23876\/j.krcp.21.281","article-title":"Impact of needle type on substitution volume during online hemodiafiltration: Plastic cannulae versus metal needles","volume":"42","author":"Cho","year":"2023","journal-title":"Kidney Res. Clin. Pract."},{"key":"ref_19","unstructured":"R Core Team (2025). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1159\/000529719","article-title":"Better Anti-Spike IgG Antibody Response to SARS-CoV-2 Vaccine in Patients on Haemodiafiltration than on Haemodialysis","volume":"52","author":"Carrera","year":"2023","journal-title":"Blood Purif."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1681\/ASN.2012080875","article-title":"High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients","volume":"24","author":"Maduell","year":"2013","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.kint.2017.01.013","article-title":"Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly","volume":"91","author":"Morena","year":"2017","journal-title":"Kidney Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1093\/ndt\/gfs407","article-title":"Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: Results from the Turkish OL-HDF Study","volume":"28","author":"Ok","year":"2013","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1093\/ckj\/sfw140","article-title":"Achieving high convection volumes in postdilution online hemodiafiltration: A prospective multicenter study","volume":"10","author":"Chapdelaine","year":"2017","journal-title":"Clin. Kidney J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1159\/000362108","article-title":"Treatment policy rather than patient characteristics determines convection volume in online post-dilution hemodiafiltration","volume":"37","author":"Chapdelaine","year":"2014","journal-title":"Blood Purif."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3493","DOI":"10.1093\/ndt\/gfp265","article-title":"Patient- and treatment-related determinants of convective volume in post-dilution haemodiafiltration in clinical practice","volume":"24","author":"Penne","year":"2009","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"244","DOI":"10.5301\/ijao.5000414","article-title":"Modifiable factors associated with achievement of high-volume post-dilution hemodiafiltration: Results from an international study","volume":"38","author":"Marcelli","year":"2015","journal-title":"Int. J. Artif. Organs"}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/1\/20\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T10:28:37Z","timestamp":1767608917000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/1\/20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,4]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diseases14010020"],"URL":"https:\/\/doi.org\/10.3390\/diseases14010020","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,4]]}}}