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
Ahlmann C, Stronach L, Waters K, Walker K, Oh J, Schmitt CP, Ranchin B, Shroff R
Pediatr Nephrol. 2024 Feb 13. doi: 10.1007/s00467-024-06285-w

Nutritional and Anthropometric Indices in Children Receiving Haemodiafiltration vs Conventional Haemodialysis - The HDF, Heart and Height (3H) Study
Paglialonga F, Monzani A, Prodam F, ….Shroff R.
J Ren Nutr. 2023 Jan;33(1):17-28. doi: 10.1053/j.jrn.2022.07.005.

Hemodiafiltration maintains a sustained improvement in blood pressure compared to conventional hemodialysis in children-the HDF, heart and height (3H) study
De Zan F, Smith C, Duzova A, …Shroff R.
Pediatr Nephrol. 2021 Aug;36(8):2393-2403. doi: 10.1007/s00467-021-04930-2.

Hemodiafiltration Is Associated With Reduced Inflammation and Increased Bone Formation Compared With Conventional Hemodialysis in Children: The HDF, Hearts and Heights (3H) Study
Fischer DC, Smith C, De Zan F, ….Shroff R.
Kidney Int Rep. 2021 Jul 6;6(9):2358-2370. doi: 10.1016/j.ekir.2021.06.025.

Haemodiafiltration does not lower protein-bound uraemic toxin levels compared with haemodialysis in a paediatric population
Snauwaert E, Van Biesen W, Raes A, ….Shroff R, Eloot S.
Nephrol Dial Transplant. 2020 Apr 1;35(4):648-656. doi: 10.1093/ndt/gfz132.

Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study
Shroff R, Smith C, Ranchin B, et al.
J Am Soc Nephrol. 2019 Apr;30(4):678-691. doi: 10.1681/ASN.2018100990.

Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population
Snauwaert E, Holvoet E, Van Biesen W, ….Shroff R.|
Toxins (Basel). 2019 Apr 24;11(4):235. doi: 10.3390/toxins11040235.

Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children
Agbas A, Canpolat N, Caliskan S, Yilmaz A, Ekmekci H, Mayes M, Aitkenhead H, Schaefer F, Sever L, Shroff R
PLoS One 13:e0198320, 2018

Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children - the HDF, heart and height (3H) study
Shroff R, Bayazit A, Stefanidis CJ, Askiti V, Azukaitis K, ..., Schaefer F, Schmitt CP
BMC Nephrol 19:199, 2018

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