Hemofiltration 

is a therapy similar to hemodialysis, used to replace the function of the kidneys in the case
of renal failure. Unlike hemodialysis, hemofiltration is nearly always used in intensive care settings in
cases of acute renal failure. The therapy works by passing the patient's blood through a machine that
filters out waste products and water, and then adds replacement fluid before returning the blood to the
body. The replacement fluid maintains fluid volume in the blood and provides electrolytes.

Hemofiltration is a lengthy, continuous procedure, usually requiring 12 to 24 hours per session. It is

usually performed daily for as long as necessary. Acute renal failure can be reversed if treatment begins
early enough.

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Hemofiltration mainly differs from dialysis in the method of filtration. Both procedures use a semi-
permeable membrane to filter the blood, but hemofiltration uses convection along with diffusion, while
dialysis uses diffusion alone. Convection allows positive fluid pressure to drive water and solutes through
the filtering membrane. Diffusion is simply the random motion of particles in the blood, so larger solutes
are not filtered as quickly as smaller ones because they move more slowly.

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Extracorporeal
 
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The convection method solves the problem inherent in diffusion alone, allowing solutes of all sizes to be
filtered at a similar rate. The rate of filtration of both large and small solutes can be even more balanced
by the use ofhemofiltration and dialysis in tandem. This procedure is known as hemodiafiltration.

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The replacement fluid used in hemofiltration contains either lactate or acetate to generate

the electrolytebicarbonate, or bicarbonate on its own. Lactate can cause problems for certain patients,
such as those with liver disease or lactate acidosis, a condition in which the buildup of lactic acid in the
bloodstream causes the blood to become acidic. Bicarbonate is commonly used for such patients.

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Hemofiltration and hemodiafiltration may be performed either continuously or intermittently. The on-line,

intermittent method can be used for outpatient treatment, while the continuous method is normally used in
intensive care. The intermittent method prepares replacement fluid on-line by filtering the dialysis fluid,
while the continuous method uses pre-packaged, sterile, commercially prepared replacement fluid.

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Intermittent filtration therapies are not currently approved by the United States regulatory agencies, and
hemodiafiltration is rarely used in outpatient care in the United States. In Europe, however, the practice is
more common, though still somewhat controversial. Recent studies have suggested that intermittent
hemodiafiltration may be a more effective therapy than dialysis, but more extensive studies, including
randomized controlled clinical trials, are required before the issue can be settled.

Renal Dialysis
 
Acute Dialysis
 
Extracorporeal
 
Dialysis Machines
 
Liver Dialysis
 
Kidney Dialysis Machine
 
Renal Replacement Therapy

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