High Volume Hemofiltration : what are the last indications in 2026 - a narrative review-

High-dose continuous therapies and especially High-volume hemofiltration has failed to demonstrate clinical benefit in septic shock and is therefore no longer recommended in this setting. However, extrapolating this negative conclusion to all clinical indications may be inappropriate. This narrative review revisits the current and emerging indications for High-dose continuous therapies beyond sepsis, focusing on pathophysiological rationale and toxin kinetics. Recent evidence, notably the CONVINCE trial, has established High-volume Intermittent post-dilution online Hemodiafiltration as superior to conventional hemodialysis in chronic kidney disease, likely through enhanced removal of middle and protein-bound uremic toxins. In acute settings, High-dose continuous therapies strategies play a critical neuroprotective role in hyperammonemia—both hepatic and non-hepatic—as well as in selected severe drug intoxications, including valproate, metformin, and lithium. When appropriately selected and adequately dosed, High-dose continuous therapies remain powerful, targeted tools in modern blood purification.