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.

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.

Additional publications:	Agbas A, Canpolat N, Caliskan S, Yilmaz A, Ekmekci H, Mayes M, Aitkenhead H, Schaefer F, Sever L, Shroff R: Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children . PLoS One 13:e0198320, 2018 Shroff R, Bayazit A, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Agbas A, Anarat A, Aoun B, Bakkaloglu S, Bhowruth D, Borzych-Duzalka D, Bulut IK, Buscher R, 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, Ranchin B, Samaille C, Shenoy M, Sinha M, Smith C, Spasojevic B, Vidal E, Vondrak K, Yilmaz A, Zaloszyc A, Fischbach M, Schaefer F, Schmitt CP: Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children - the HDF, heart and height (3H) study . 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:	Great Ormond Street Hospital for Children NHS Foundation Trust, and University College London Institute of Child Health, London, UK Institute for Global Health, UCL, London, UK Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France Cukurova University, Adana, Turkey A & P Kyriakou Children’s Hospital, Athens, Greece Clinic of Pediatrics, Vilnius University, Vilnius, Lithuania Cerrahpasa School of Medicine, Istanbul, Turkey Armand Trousseau Hospital, Paris, France Gazi University Hospital, Ankara, Turkey Medical University of Gdansk, Gdansk,Poland Ege University Faculty of Medicine, Izmir, Turkey University Children Hospital Essen, Essen, Germany Hacettepe University, Ankara, Turkey University Hospital Cologne, Cologne, Germany University Hospital of Wales, Cardiff, UK Hôpital Necker-Enfants Malades, Paris, France The Hospital for Sick Children, Toronto, Canada Children's Memorial Health Institute, Warsaw, Poland Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy Bambino Gesù" Children Research Hospital, IRCCS. Rome, Italy Hôpital Jeanne De Flandre, Lille Cedex, France Royal Manchester Children’s Hospital, Manchester, UK Kings College London, Evelina London Children's Hospital, London, UK University Children's Hospital, Belgrade, Serbia Pediatric Dialysis and Transplant Unit, Padova, Italy University Hospital Motol, Prague, Czech Republic Istanbul University Faculty of Medicine, Istanbul, Turkey Children's Dialysis Center, Strasbourg, France Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
Contact Information:	Rukshana Shroff

Active ESCAPE Participants:

Franz Schaefer

Rukshana Shroff