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Effects of hemodiafiltration versus conventional hemodialysis in children with ESKD: The HDF, heart and height study

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Rukshana Shroff, Colette Smith, Bruno Ranchin, Aysun K. Bayazit, Constantinos J. Stefanidis, Varvara Askiti, Karolis Azukaitis, Nur Canpolat, Ayşe Agba, Helen Aitkenhead, Ali Anarat, Bilal Aoun, Daley Aofolaju, Sevcan Azime Bakkaloglu, Devina Bhowruth, Dagmara Borzych-Duza, Ipek Kaplan Bulut, Rainer Büscher, John Deanfield, Claire Dempster & 25 more Ali Duzova, Sandra Habbig, Wesley Hayes, Shivram Hegde, Saoussen Krid, Christoph Licht, Mieczyslaw Litwin, Mark Mayes, Sevgi Mir, Rose Nemec, Lukasz Obrycki, Fabio Paglialonga, Stefano Picca, Charlotte Samaille, Mohan Shenoy, Manish D. Sinha, Brankica Spasojevic, Lynsey Stronach, Enrico Vidal, Karel Vondrák, Alev Yilmaz, Ariane Zaloszyc, Michel Fischbach, Claus Peter Schmitt, Franz Schaefer

Original languageEnglish
Pages (from-to)678-691
Number of pages14
JournalJournal of the American Society of Nephrology
Issue number4
Published1 Apr 2019

King's Authors


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 b2-microglobulin. The HDF cohort had lower b2-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.

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