An Indian consensus on the use of online hemodiafiltration in patients with chronic kidney disease.

BACKGROUND: Advances in dialysis technology have improved the management of end-stage kidney disease; however, survival rates and quality of life on conventional hemodialysis (HD) remain suboptimal Hemodiafiltration (HDF) offers superior clearance of middle molecules, improved hemodynamic stability, and reduced mortality than conventional hemodialysis (HD). Despite these advantages, HDF adoption in India remains inconsistent due to lack of national guidelines, cost concerns, and limited awareness of long-term benefits. METHODS: A modified Delphi methodology was utilized to develop consensus-based recommendations on the use of HDF in India. A panel of 11 experienced nephrologists from diverse clinical settings participated in multiple rounds of discussions. Consensus statements were formulated across six domains: patient selection, dialysis adequacy, vascular access, therapy goals and outcome, HDF utilization techniques, and patient involvement in HDF therapy. Consensus required >90% agreement ("Agree" or "Strongly Agree") on a 5-point Likert scale. RESULTS: A total of 50 draft consensus statements on HDF were developed and subjected to anonymous voting by the expert panel. In the first voting round, 46 statements met the predefined consensus threshold. Four statements that did not reach consensus were revised following discussion in a second virtual meeting. Ultimately, 48 of 50 statements achieved consensus, while 2 were discarded due to lack of agreement. CONCLUSION: This consensus demonstrated strong agreement among Indian nephrologists on key aspects of HDF, including patient selection, therapy goals, and technical considerations. These recommendations aim to standardize HDF practice and promote its wider adoption in India, ultimately improving care quality and outcomes for patients with chronic kidney disease requiring kidney replacement therapy.