Kidney Week

Abstract: SA-OR041

Haemodiafiltration (HDF) Improves the Cardiovascular Risk Profile Compared to Conventional Haemodialysis (HD) in Children – The HDF, Heart, and Height (3H) Trial

Session Information

• Pediatric Nephrology and Developmental Biology
  November 04, 2017 | Location: Room 285, Morial Convention Center
  Abstract Time: 04:30 PM - 04:42 PM

Category: Dialysis

• 601 Standard Hemodialysis for ESRD

Authors

• Shroff, Rukshana, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom

Rukshana Shroff, MD, PhD



Rukshana Shroff, MD, FRCPCH, PhD, is a Consultant in Paediatric Nephrology at Great Ormond Street Hospital for Children in London UK, and Reader at University College London. Her research focuses on cardiovascular disease in childhood chronic kidney disease (CKD), including laboratory work, clinical research studies and clinical trials. She is the PI on a multicentre study comparing long-term outcomes of conventional hemodialysis and hemodiafiltration in children. She currently holds a senior fellowship from the National Institute for Health Research (NIHR) to continue research into mineral dysregulation in CKD. She has been Chief Investigator for a number of multicentre clinical trials, and has supervised 9 MD / PhD fellows. She has published more than 130 original articles, reviews and book chapters in the fields of nephrology and dialysis. Dr Shroff has served on the recent KDIGO CKD-MBD guideline update group, a guideline development group with the International Society for Peritoneal Dialysis and two guideline committees for the National Institute for Health and Care Excellence (NICE). She is on the Council for the European Society for Pediatric Nephrology. She is currently an Associate Editor for Pediatric Nephrology and serves on the editorial board of the Clinical Journal of the American Society of Nephrology.

• Smith, Colette J, University College London, London, United Kingdom

Colette J Smith,

• Azukaitis, Karolis, Vilnius University, Lithuania, Vilnius, Lithuania

Karolis Azukaitis,

• Stefanidis, Constantinos J., A. and P. Kyriakou Childrens Hospital Athens, Greece, Athens, Greece

Constantinos J. Stefanidis,

• Canpolat, Nur, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey

Nur Canpolat,

• Krid, Saoussen, Hôpital, Paris, France

Saoussen Krid,

• Litwin, Mieczys?aw P., The Children's Memorial Health Institute, Warsaw, Warsaw, Poland

Mieczys?aw P. Litwin,

• Schaefer, Franz S., University of Heidelberg, Heidelberg, BW, Germany

Franz S. Schaefer,

Group or Team Name

• On behalf of International Pediatric Hemodialysis Network and 4C study investigators

Background

Fluid overload, hypertension and cardiovascular disease are common in children on dialysis. In adults, HDF is shown to reduce cardiovascular mortality, but causes for this are not clear and data in children are scarce.

Methods

We performed a non-randomized parallel-arm clinical trial within the International Pediatric Hemodialysis Network registry to assess changes in fluid status, BP, biochemistry and cardiovascular measures in children on HDF compared with conventional HD. The primary outcome measure was change in carotid intima media thickness standard deviation score (cIMT SDS) at 1-year. (ClinicalTrials.gov NCT02063776)

Results

190 children (from 28 centres across Europe and North America) were recruited, and 179 fulfilled inclusion criteria. 134 children (78 on HD and 56 on HDF) completed one-year follow-up. There was no difference between HD and HDF groups in age, gender, underlying renal disease, dialysis vintage, access type, blood flow or residual renal function. There were 45 drop-outs, mainly (75%) due to transplantation; there were no deaths. The median convective volume achieved in the HDF group was 13.3 (inter-quartile range 12.4 to 14.5) ml/m²/session.

At 1-year, children on HDF had lower cIMT SDS and lower pulse wave velocity-SDS compared to those on conventional HD (1.88 vs 2.64; p=0.007 and 0.77 vs 1.99, p<0.001 respectively). Annualised change in cIMT SDS was 10-fold lower in HDF compared to HD (0.013 vs 0.48; p=0.002). 24-hour mean arterial pressure, left ventricular mass index and parathyroid hormone level were also significantly lower on HDF (p<0.01 for all). On univariable analysis the HDF vs HD group, serum phosphate and PTH and dialysate water quality significantly associated with cIMT SDS. On multivariable linear regression analysis, the annualised change in cIMT SDS was 0.3 higher (95%CI -0.01 to 0.61) and PWV SDS was 0.26 higher (95%CI -0.4 to 0.9) in children on HD compared to those on HDF. All data were adjusted for centre and baseline cIMT-SDS.

Conclusion

In children, HDF attenuates the progression of vascular disease compared to conventional HD. This may be due to improved fluid and BP control as well as normalisation of phosphate and PTH levels.