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Kidney Week

Abstract: PO2329

Hemodiafiltration Maintains a Sustained Improvement in BP Compared with Conventional Hemodialysis in Children: The HDF, Heart and Height (3H) Study

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • De Zan, Francesca, University Hospital of Padova, Padova, Padova, Italy
  • Smith, Colette J., UCL Institute of Global Health, London, United Kingdom
  • Bayazit, Aysun, Cukurova University, Adana, Turkey
  • Azukaitis, Karolis, Clinic of Pediatrics, Vilnius University, Vilnius, Lithuania
  • Bakkaloglu, Sevcan A., Gazi University Hospital, Ankara, Turkey
  • Paglialonga, Fabio, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  • Shenoy, Mohan, Royal Manchester Children’s Hospital, Manchester, United Kingdom
  • Sinha, Manish, Evelina Children's Hospital, London, United Kingdom
  • Spasojevic, Brankica B., University Children's Hospital, Belgrade, Serbia
  • Schmitt, Claus peter, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
  • Schaefer, Franz S., Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
  • Vidal, Enrico, Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
  • Shroff, Rukshana, Great Ormond Street Hospital for Children NHS Foundation Trust, and University College London Institute of Child Health, London, United Kingdom
Background

Hypertension is prevalent in children on dialysis and associated with left ventricular hypertrophy, cardiovascular disease, and mortality. We studied the blood pressure (BP) trends as well as risk factors associated with the evolution of BP over 1-year in children on conventional hemodialysis (HD) vs hemodiafiltration (HDF)

Methods

This is a post-hoc analysis of the “3H - HDF-Hearts-Height” dataset, a multicenter, non-randomized, parallel-arm observational study. Mean arterial pressure (MAP) derived from 24-hour ambulatory BP monitoring was calculated and hypertension defined as 24-hour MAP standard deviation score (SDS) ≥95th percentile

Results

78 children on HD and 55 on HDF who were followed-up for 1-year and had three ABPM measures were included. MAP-SDS was under-estimated by pre-dialysis systolic BP-SDS (mean difference -0.6; 95% LoA -4.9 to 3.8). At baseline 82% on HD and 44% on HDF were hypertensive, with uncontrolled hypertension (BP>95th centile on medications) in 88% vs 25% respectively; p<0.001. At 12-months children on HDF had lower MAP-SDS compared to those on HD in all age groups (p<0.001). Over the one-year follow-up, the HD group had a mean MAP-SDS increase of +0.98 (95%CI 0.77 to 1.20; p<0.0001), whereas the HDF group had a non-significant increase of +0.15 (95%CI -0.10 to 0.40; p=0.23). Significant and independent predictors of MAP-SDS were dialysis modality (β=0.83 [95%CI 0.51 to 1.15] SDS for HD vs HDF, p<0.0001) and higher IDWG% (β=0.13 [95%CI 0.06 to 0.19] p=0.0003)

Conclusion

Children on HD had a significant and sustained increase in BP over the 1-year study period compared to an attenuated and non-significant increase in HDF. Volume overload with higher IDWG%, but not anti-hypertensive medications, was associated with a higher MAP-SDS in both groups