Acetate-free biofiltration is a dialysis method with high biocompatibility. The lack of acetate results in decreased stimulation of the production of inflammatory mediators. Other favorable features have been added over the years, such as the possibility to modulate the concentration of potassium in the dialysate, thereby reducing the risk of arrhythmias; the possibility to constantly monitor the blood volume during treatment to reduce the risk of intradialytic hypotension; and a reduced need for heparin thanks to a membrane with a specially treated surface. In this review we discuss the specifics of acetate-free biofiltration.