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Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study
- Source :
- Journal of the American Society of Nephrology : JASN. 30(4)
- Publication Year :
- 2018
-
Abstract
- EgeUn###<br />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 2-microglobulin. The HDF cohort had lower 2-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.<br />National Institute for Health ResearchNational Institute for Health Research (NIHR); Kidney Research UKKidney Research UK (KRUK); Fresenius Medical Care<br />R.S. holds a Career Development Fellowship with the National Institute for Health Research. The 3H study was sponsored by Kidney Research UK. Part sponsorship was obtained from Fresenius Medical Care.
- Subjects :
- Male
medicine.medical_treatment
030232 urology & nephrology
Medizin
Blood Pressure
030204 cardiovascular system & hematology
Carotid Intima-Media Thickness
law.invention
Kidney Failure
Hemoglobins
0302 clinical medicine
Randomized controlled trial
law
cardiovascular disease
Chronic
Child
hemodialysis
integumentary system
Headache
General Medicine
Hospitalization
C-Reactive Protein
Nephrology
Parathyroid Hormone
Child, Preschool
Cohort
Hypertension
Cardiology
Female
Hemodialysis
carotid intima-media thickness
children
growth
hemodiafiltration (HDF)
Adolescent
Dizziness
Humans
Kidney Failure, Chronic
Muscle Cramp
Patient Reported Outcome Measures
Phosphates
Renal Dialysis
Young Adult
beta 2-Microglobulin
Body Height
Hemodiafiltration
medicine.medical_specialty
Mean arterial pressure
Renal function
03 medical and health sciences
Clinical Research
Internal medicine
medicine
Preschool
Dialysis
business.industry
Propensity score matching
Observational study
business
Subjects
Details
- ISSN :
- 15333450
- Volume :
- 30
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of the American Society of Nephrology : JASN
- Accession number :
- edsair.doi.dedup.....7bdd409d50e02ab73e578ac8c5dfb204