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J Am Soc Nephrol. 2019 Apr;30(4):678-691. doi: 10.1681/ASN.2018100990. Epub 2019 Mar 7.

Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study.

Author information

1
Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and Rukshana.Shroff@gosh.nhs.uk.
2
Vascular Physiology Unit, University College London Institute of Child Health, Gower Street, London, United Kingdom.
3
Statistics Department, Institute for Global Health, University College London, London, United Kingdom.
4
Renal Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
5
Nephrology Unit, Cukurova University, Adana, Turkey.
6
Nephrology Unit, Kyriakou Children's Hospital, Athens, Greece.
7
Nephrology Unit, Clinic of Pediatrics, Vilnius University, Vilnius, Lithuania.
8
Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey.
9
Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and.
10
Nephrology Unit, Armand Trousseau Hospital, Paris, France.
11
Nephrology Unit, Gazi University Hospital, Ankara, Turkey.
12
Nephrology Unit, Medical University of Gdansk, Gdansk, Poland.
13
Nephrology Unit, Ege University Faculty of Medicine, Izmir, Turkey.
14
Nephrology Unit, University Children Hospital Essen, Essen, Germany.
15
Nephrology Unit, Hacettepe University, Ankara, Turkey.
16
Nephrology Unit, University Hospital Cologne, Cologne, Germany.
17
Nephrology Unit, University Hospital of Wales, Cardiff, United Kingdom.
18
Nephrology Unit, Hôpital Necker-Enfants Malades, Paris, France.
19
Nephrology Unit, The Hospital for Sick Children, Toronto, Canada.
20
Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland.
21
Nephrology Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
22
Nephrology Unit, Bambino Gesù" Children Research Hospital, Rome, Italy.
23
Nephrology Unit, Hôpital Jeanne De Flandre, Lille Cedex, France.
24
Nephrology Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom.
25
Nephrology Unit, Kings College London, Evelina London Children's Hospital, London, United Kingdom.
26
Nephrology Unit, University Children's Hospital, Belgrade, Serbia.
27
Nephrology Unit, Pediatric Dialysis and Transplant Unit, Padova, Italy.
28
Nephrology Unit, University Hospital Motol, Prague, Czech Republic.
29
Nephrology Unit, Istanbul University Faculty of Medicine, Istanbul, Turkey.
30
Nephrology Unit, Children's Dialysis Center, Strasbourg, France; and.
31
Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.

Abstract

BACKGROUND:

Hypertension and cardiovascular disease are common in children undergoing dialysis. Studies suggest that hemodiafiltration (HDF) may reduce cardiovascular mortality in adults, but data for children are scarce.

METHODS:

The HDF, Heart and Height study is a nonrandomized observational study comparing outcomes on conventional hemodialysis (HD) versus postdilution online HDF in children. Primary outcome measures were annualized changes in carotid intima-media thickness (cIMT) SD score and height SD score.

RESULTS:

We enrolled 190 children from 28 centers; 78 on HD and 55 on HDF completed 1-year follow-up. The groups were comparable for age, dialysis vintage, access type, dialysis frequency, blood flow, and residual renal function. At 1 year, cIMT SD score increased significantly in children on HD but remained static in the HDF cohort. On propensity score analysis, HD was associated with a +0.47 higher annualized cIMT SD score compared with HDF. Height SD score increased in HDF but remained static in HD. Mean arterial pressure SD score increased with HD only. Factors associated with higher cIMT and mean arterial pressure SD-scores were HD group, higher ultrafiltration rate, and higher β2-microglobulin. The HDF cohort had lower β2-microglobulin, parathyroid hormone, and high-sensitivity C-reactive protein at 1 year; fewer headaches, dizziness, or cramps; and shorter postdialysis recovery time.

CONCLUSIONS:

HDF is associated with a lack of progression in vascular measures versus progression with HD, as well as an increase in height not seen in the HD cohort. Patient-related outcomes improved among children on HDF correlating with improved BP control and clearances. Confirmation through randomized trials is required.

KEYWORDS:

cardiovascular disease; carotid intima-media thickness; children; growth; hemodiafiltration (HDF); hemodialysis

PMID:
30846560
PMCID:
PMC6442347
[Available on 2020-04-01]
DOI:
10.1681/ASN.2018100990

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