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Shroff R, Smith C, Ranchin B, Bayazit AK, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Ağbaş A, Aitkenhead H, Anarat A, Aoun B, Aofolaju D, Bakkaloglu SA, Bhowruth D, Borzych-Dużałka D, Bulut IK, Büscher R, Deanfield J, Dempster C, Duzova A, Habbig S, Hayes W, Hegde S, Krid S, Licht C, Litwin M, Mayes M, Mir S, Nemec R, Obrycki L, Paglialonga F, Picca S, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Stronach L, Vidal E, Vondrák K, Yilmaz A, Zaloszyc A, Fischbach M, Schmitt CP, Schaefer F. Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study. J Am Soc Nephrol 2019; 30:678-691. [PMID: 30846560 DOI: 10.1681/asn.2018100990] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/26/2019] [Indexed: 12/15/2022] Open
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.
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Affiliation(s)
- Rukshana Shroff
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and .,Vascular Physiology Unit, University College London Institute of Child Health, Gower Street, London, United Kingdom
| | - Colette Smith
- Statistics Department, Institute for Global Health, University College London, London, United Kingdom
| | - Bruno Ranchin
- Renal Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | | | - Varvara Askiti
- Nephrology Unit, Kyriakou Children's Hospital, Athens, Greece
| | - Karolis Azukaitis
- Nephrology Unit, Clinic of Pediatrics, Vilnius University, Vilnius, Lithuania
| | - Nur Canpolat
- Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ayşe Ağbaş
- Nephrology Unit, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Helen Aitkenhead
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Ali Anarat
- Nephrology Unit, Cukurova University, Adana, Turkey
| | - Bilal Aoun
- Nephrology Unit, Armand Trousseau Hospital, Paris, France
| | - Daley Aofolaju
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | | | - Devina Bhowruth
- Vascular Physiology Unit, University College London Institute of Child Health, Gower Street, London, United Kingdom
| | | | | | - Rainer Büscher
- Nephrology Unit, University Children Hospital Essen, Essen, Germany
| | - John Deanfield
- Vascular Physiology Unit, University College London Institute of Child Health, Gower Street, London, United Kingdom
| | - Claire Dempster
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Ali Duzova
- Nephrology Unit, Hacettepe University, Ankara, Turkey
| | - Sandra Habbig
- Nephrology Unit, University Hospital Cologne, Cologne, Germany
| | - Wesley Hayes
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Shivram Hegde
- Nephrology Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Saoussen Krid
- Nephrology Unit, Hôpital Necker-Enfants Malades, Paris, France
| | - Christoph Licht
- Nephrology Unit, The Hospital for Sick Children, Toronto, Canada
| | - Mieczyslaw Litwin
- Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland
| | - Mark Mayes
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Sevgi Mir
- Nephrology Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Rose Nemec
- Nephrology Unit, The Hospital for Sick Children, Toronto, Canada
| | - Lukasz Obrycki
- Nephrology Unit, Children's Memorial Health Institute, Warsaw, Poland
| | - Fabio Paglialonga
- Nephrology Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Picca
- Nephrology Unit, Bambino Gesù" Children Research Hospital, Rome, Italy
| | | | - Mohan Shenoy
- Nephrology Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Manish D Sinha
- Nephrology Unit, Kings College London, Evelina London Children's Hospital, London, United Kingdom
| | | | - Lynsey Stronach
- Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
| | - Enrico Vidal
- Nephrology Unit, Pediatric Dialysis and Transplant Unit, Padova, Italy
| | - Karel Vondrák
- Nephrology Unit, University Hospital Motol, Prague, Czech Republic
| | - Alev Yilmaz
- Nephrology Unit, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ariane Zaloszyc
- Nephrology Unit, Children's Dialysis Center, Strasbourg, France; and
| | - Michel Fischbach
- Nephrology Unit, Children's Dialysis Center, Strasbourg, France; and
| | - Claus Peter Schmitt
- Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Franz Schaefer
- Nephrology Unit, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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