Abstract: High volume hemodiafiltration (HVHDF) has been proven to reduce the risk of death in dialysis patients, but the existing evidence mainly comes from the European population. Recent clinical data from Fresenius Kidney Care (FKC) Singapore demonstrated consistent achievement of convection volume targets across diverse ethnic groups. Patients with Chinese ethnicity, representing the majority, achieved outcomes comparable to global benchmarks. Moreover, HVHDF may offer reduced hospitalization burden compared to conventional HD, and better symptom control as adjudged by patient reported outcomes. Singapore’s experience affirms that HVHDF can be safely and effectively integrated into routine care, in a multi-ethnic group, offering a scalable model for improving dialysis outcomes in Asia. This review explores the institutional, operational, and clinical enablers that supported the implementation of HVHDF in Singapore to distil practical lessons applicable for broader HDF implementation across Asia.

Key words: End stage kidney disease, Singapore, High volume Hemodiafiltration, Operational protocols, Therapy monitoring