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First, the double chamber of the HFR filter allows complete separation of convection and diffusion,7 so that the same volume of ultrafiltrate obtained in the first chamber is returned as replacement fluid to the blood circuit just before the second chamber of the filter, allowing lower dialysis water consumption and zero risk of back-filtration.25 Secondly, the regeneration of ultrafiltrate after its passage through the adsorber cartridge minimizes the risk of loss of albumin and of other nutrients that has been described with OL-HDF.56,57 Third, in HFR the reinfusion volume delivered is about 15 L per session,50 whereas in OL-HDF the convective target is at least 2123 L per session in postdilution,58 the latter being an unfeasible target in patients with suboptimal vascular access.5860 Finally, while the performance of OL-HDF benefits from an increase in infusion flow (QI) by increasing QB,61 in the case of HFR the excessive increase in endogenous QUF facilitated by an increase in QB may be counterproductive by decreasing the adsorptive efficacy of the technique.44,55,62,63 In conclusion, HFR allows more adequate removal of medium molecular weight molecules than OL-HDF in comorbid patients with limited vascular access who do not reach a high convective volume.50,59 Clinical benefits described with HFRToxin removal with HFR Different studies have demonstrated the ability of HFR to remove a broad spectrum of uremic toxins, including PBUTs (Table 3)

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