Hemodiafiltration in Japan: current status and future directions

Hemodiafiltration (HDF) therapy has become standard treatment in Japan and Europe, but evidence from Europe is not directly applicable to HDF in Japan because HDF therapy differs greatly in the two regions. Japanese dialysis membranes vary widely, including use of protein-leaking and non-leaking membranes, and the molecular weight of solutes that can be removed is generally larger in Japan than in Europe. Given the characteristics of pre-dilution, the volume of replacement fluid itself cannot be used as a marker for solute removal, and the relationship of this volume to life prognosis is still unknown. Under these circumstances, the JAMREDS, a multicenter study led by the Japanese Society for Hemodiafiltration, was started in April 2020. The goal of the study is to determine whether α1-microglobulin reduction rate can be used as a marker for the prognosis of hemodialysis patients, including life prognosis and cardiovascular event onset. The JAMREDS is being performed from a new perspective of solute removal by HDF. This research design is reasonable and highly original for HDF in Japan, in view of the wide variety of membrane types and treatment modes, and the results of the study will be of particular interest.