The regeneration of large volumes of ultrafiltrate plasma obtained in the first HFR filter allows a large volume of plasma water to be treated, and at the same time, enables the return of many valuable substances such as hormones, small peptides and many vitamins.25 The blood with the clean ultrafiltrate then passes through a low-flux filter (diffusive phase) which allows the removal of small molecules, as well as the ultrafiltration necessary to achieve an adequate water balance in the patient.30 Historical evolution of HFR HFR evolved from HDF with separate diffusion and convection (PFD, Paired Filtration-Dialysis) using a hydraulically separated dual-chamber filter of different permeability,31 to which a carbon adsorbent cartridge was added.32,33 From the beginning, HFR proved to be a well-tolerated and highly biocompatible technique, with a lower inflammatory response and the ability to scavenge medium-sized molecules such as 2-microglobulin ( 2-m).34,35 The development of HFR was a complex process that underwent numerous evolutionary changes to find a suitable adsorbent that would retain a wide variety of mediators and at the same time be suitable for extracorporeal treatment, with HFR-supra being the most effective and current version (Table 1).3646 Characteristics and historical evolution of the various HFR modalities.40
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