Which ESKD patients would you consider transitioning from hemodialysis to hemodiafiltration, given the FDA approval of a hemodiafiltration system in the US?

I believe once operational, we can transition all the patients in the dialysis unit equipped to perform it. In general, convention removes larger molecular weight substances, so patients who may derive the most benefit may be those who have, for example, dialysis-associated amyloidosis/carpal tunnel...

As mentioned above, hemodiafiltration increases convection (pressure/diffusion), and so increases clearance for both large molecules and small molecules (using standard high flux dialyzers). So urea clearance also increases, meaning this would also be good for patients who are barely making Kt/V cle...

I would consider it for patients with prolonged post-dialysis fatigue as well, as there is some data to suggest improvement in symptoms with hemodiafiltration as well. It would be interesting to see the effect on patients with intradialytic symptoms and intradialytic hypotension as well.