Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study.
Adolescent
Blood Pressure
Body Height
C-Reactive Protein
Carotid Intima-Media Thickness
Child
Child, Preschool
Dizziness
/ etiology
Female
Headache
/ etiology
Hemodiafiltration
/ adverse effects
Hemoglobins
/ metabolism
Hospitalization
Humans
Hypertension
/ etiology
Kidney Failure, Chronic
/ blood
Male
Muscle Cramp
/ etiology
Parathyroid Hormone
/ blood
Patient Reported Outcome Measures
Phosphates
/ blood
Renal Dialysis
/ adverse effects
Young Adult
beta 2-Microglobulin
/ blood
cardiovascular disease
carotid intima-media thickness
children
growth
hemodiafiltration (HDF)
hemodialysis
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
07
10
2018
accepted:
26
01
2019
pubmed:
9
3
2019
medline:
19
12
2019
entrez:
9
3
2019
Statut:
ppublish
Résumé
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. 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. 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 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.
Sections du résumé
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
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.
Identifiants
pubmed: 30846560
pii: ASN.2018100990
doi: 10.1681/ASN.2018100990
pmc: PMC6442347
doi:
Substances chimiques
Hemoglobins
0
Parathyroid Hormone
0
Phosphates
0
beta 2-Microglobulin
0
C-Reactive Protein
9007-41-4
Types de publication
Comparative Study
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
678-691Informations de copyright
Copyright © 2019 by the American Society of Nephrology.
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