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.
Published in JASN March 2019:
Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study
Shroff R. et al; J Am Soc Nephrol. 2019 Mar 7.
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:|| |
|Contact Information:||Rukshana Shroff|
Active ESCAPE Participants: