3H - HDF vs HD study
HDF, Heart and Height study
Background: Hypertension and cardiovascular disease are common in children on dialysis. In adults, hemodiafiltration (HDF) may reduce cardiovascular mortality, but data in children are scarce.
Methods: We performed a non-randomized study comparing outcomes on conventional hemodialysis (HD) versus post-dilution on-line HDF: the HDF, Heart and Height (3H) study. Co-primary outcome measures were annualised changes in carotid intima-media thickness standard deviation score (cIMT-SDS) and height-SDS. 190 children from 28 centres were enrolled, and 133 (78 HD and 55 HDF) completed 1-year follow-up. HD and HDF groups were comparable for age, dialysis vintage, access type, dialysis frequency, blood flow and residual renal function.
Results: At 1-year, cIMT-SDS increased significantly in HD but remained static in the HDF cohort. On propensity score analysis, children on HD had a +0.47 higher annualised cIMT-SDS (95%CI 0.07-0.87; p=0.02) compared to HDF. Height-SDS increased in HDF but remained static in HD. Mean arterial pressure (MAP)-SDS increased in children receiving HD but reduced in the HDF cohort. Factors associated with higher cIMT-SDS and MAP-SDS were HD group, higher ultrafiltration rate and higher β2-microglobulin. β2-microglobulin, PTH and high-sensitivity CRP were lower and hemoglobin higher in HDF patients at 1-year. Children on HDF had fewer headaches, dizziness or cramps and shorter post-dialysis recovery time.
Conclusions: 3H, the largest pediatric dialysis study to date, suggests an association between HDF modality with lack of progression in vascular measures, increase in height and improved patient-related outcomes compared to HD. This correlated with improved BP control and clearances on HDF. Confirmation through randomised trials is required.
Publications: | Hemodiafiltration for children with stage 5 chronic kidney disease: technical aspects and outcomes Nutritional and Anthropometric Indices in Children Receiving Haemodiafiltration vs Conventional Haemodialysis - The HDF, Heart and Height (3H) Study Hemodiafiltration maintains a sustained improvement in blood pressure compared to conventional hemodialysis in children-the HDF, heart and height (3H) study Hemodiafiltration Is Associated With Reduced Inflammation and Increased Bone Formation Compared With Conventional Hemodialysis in Children: The HDF, Hearts and Heights (3H) Study Haemodiafiltration does not lower protein-bound uraemic toxin levels compared with haemodialysis in a paediatric population Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children - the HDF, heart and height (3H) study |
Design: | Non-randomized, parallel-arm, prospective cohort study comparing outcomes on conventional hemodialysis (HD) versus post-dilution on-line HDF. |
Patients enrolled: | 190 children on HD or HDF recruited (study closed, and 12-month follow-up complete) |
Coordinating Center: | Great Ormond Street Hospital for Children NHS Foundation Trust |
Participating Centers: |
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Contact Information: | Rukshana Shroff |
Active ESCAPE Participants:
Further 3H Investigators:
Colette Smith, Bruno Ranchin, Constantinos J Stefanidis, Varvara Askiti, Ayşe Ağbaş, Helen Aitkenhead, Ali Anarat, Bilal Aoun, Daley Aofolaju, Sevcan Bakkaloglu, Devina Bhowruth, Dagmara Borzych-Dużałka, Rainer Büscher, John Deanfield, Claire Dempster, Sandra Habbig, Shivram Hegde, Saoussen Krid, Christoph Licht, Sevgi Mir, Rose Nemec, Fabio Paglialonga, Stefano Picca, Charlotte Samaille, Mohan Shenoy, Manish D Sinha, Brankica Spasojevic, Karel Vondrák, Michel Fischbach