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논문분류	춘계학술대회 초록집
제목	A Pragmatic In-Unit Protocol to Achieve Optimal Online Hemodiafiltration: A 2-Month Quality-Improvement Study
저자	Dong Hoon Kang
출판정보	2026; 2026(1):
키워드	Dialysis, Hemodiafiltration, High-volume HDF, Convection volume
초록	Objectives: The CONVINCE trial highlighted the clinical importance of delivering high-dose online hemodiafiltration (HDF), reinforcing that achieving adequate convective dose is a key implementation gap in routine dialysis care. We evaluated whether a stepwise, dialysis-unit protocol could convert patients receiving suboptimal HDF to predefined optimal HDF targets. Methods: Optimal HDF was defined as: (1) post-dilution HDF with convection volume >23 L/session or substitution volume >21 L/session, or (2) pre-dilution HDF with convection volume >46 L/session or substitution volume >44 L/session. Patients receiving suboptimal HDF underwent a 2-month protocol: (i) increase blood flow rate (BFR) to the maximally tolerable level (maximum 350 mL/min), (ii) escalate dialyzer pore characteristics with larger surface area when feasible, and (iii) weekly reassessment to confirm achievement of target convection volume. Results: At baseline (N=106), 35 patients (33.0%) met criteria for optimal HDF; after 2 months (N=101), this increased to 50 (49.5%). Over the protocol period, key prescription parameters increased in both dilution modes. In pre-HDF, mean blood flow rate (BFR) increased from 261.9±23.4 to 285.0±30.6 mL/min and dialyzer surface area from 1.7±0.2 to 1.9±0.4 m²; in post-HDF, BFR increased from 275.7±29.2 to 306.3±40.5 mL/min and surface area from 2.0±0.2 to 2.2±0.3 m². Convection volume increased from 40.2±16.0 to 50.1±21.5 L/session in pre-HDF and from 21.3±4.6 to 31.4±14.6 L/session in post-HDF. Conclusion: A simple, weekly monitored protocol emphasizing maximally tolerable BFR and dialyzer escalation increased achievement of optimal HDF targets within 2 months in real-world practice.
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