{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:10:32Z","timestamp":1791612632636,"version":"4.3.4"},"reference-count":171,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T00:00:00Z","timestamp":1693267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fresenius Medical Care Chile"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Dialysis treatment has improved the survival of patients with kidney failure. However, the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach that significantly improves patient outcomes by effectively eliminating medium and large uremic toxins, which explains its increasing adoption, particularly in Europe and Japan. Interest in this therapy has grown following the findings of the recently published CONVINCE study, as well as the need to understand the mechanisms behind the benefits. This comprehensive review aims to enhance the scientific understanding by explaining the underlying physiological mechanisms that contribute to the positive effects of HDF in terms of short-term benefits, like hemodynamic tolerance and cardiovascular disease. Additionally, it explores the rationale behind the medium-term clinical benefits, including phosphorus removal, the modulation of inflammation and oxidative stress, anemia management, immune response modulation, nutritional effects, the mitigation of bone disorders, neuropathy relief, and amyloidosis reduction. This review also analyzes the impact of HDF on patient-reported outcomes and mortality. Considering the importance of applying personalized uremic toxin removal strategies tailored to the unique needs of each patient, high-volume HDF appears to be the most effective treatment to date for patients with renal failure. This justifies the need to prioritize its application in clinical practice, initially focusing on the groups with the greatest potential benefits and subsequently extending its use to a larger number of patients.<\/jats:p>","DOI":"10.3390\/toxins15090531","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T08:51:14Z","timestamp":1693299074000},"page":"531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1338-0503","authenticated-orcid":false,"given":"Cristian","family":"Pedreros-Rosales","sequence":"first","affiliation":[{"name":"Departamento de Medicina Interna, Facultad de Medicina, Universidad de Concepci\u00f3n, Concepci\u00f3n 4070386, Chile"},{"name":"Nephrology Service, Hospital Las Higueras, Talcahuano 4270918, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aquiles","family":"Jara","sequence":"additional","affiliation":[{"name":"Departamento de Nefrolog\u00eda, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, Santiago 8320000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Lorca","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Facultad de Medicina, Campus Oriente, Universidad de Chile, Santiago 7500922, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Mezzano","sequence":"additional","affiliation":[{"name":"Instituto de Medicina, Facultad de Medicina, Universidad Austral, Valdivia 5110566, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Pecoits-Filho","sequence":"additional","affiliation":[{"name":"Arbor Research Collaborative for Health, Ann Arbor, MI 48108, USA"},{"name":"School of Medicine, Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, Curitiba 80215-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2218-2776","authenticated-orcid":false,"given":"Patricia","family":"Herrera","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Facultad de Medicina, Campus Oriente, Universidad de Chile, Santiago 7500922, Chile"},{"name":"Nephrology Service, Hospital del Salvador, Santiago 8320000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1056\/NEJMra0902710","article-title":"Hemodialysis","volume":"363","author":"Himmelfarb","year":"2010","journal-title":"N. 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