ESPN 50th Annual Meeting

ESPN 2017


 
HAEMODIAFILTRATION (HDF) IS ASSOCIATED WITH SUPERIOR FLUID CONTROL AND REDUCED CARDIOVASCULAR RISK PROFILE COMPARED TO CONVENTIONAL HAEMODIALYSIS (HD) – DATA FROM THE HDF VS HD (3H) STUDY
Rukshana Shroff 1 Aysun Bayazit 2 Constantinos Stefanidis 3 Varvara Askiti 3 Karolis Ažukaitis 5 Nur Canpolat 6 Sevcan Bakkaloglu 7 Salim Çaliskan 4 Devina Bhowruth 1 Dagmara Borzych-Dużałka 5 Ali Duzova 8 Sandra Habbig 9 Shivram Hegde 10 Saoussen Krid 11 Christoph Licht 12 Mieczyslav Litwin 13 Fabio Paglialonga 14 Stefano Picca 15 Bruno Ranchin 16 Charlotte Samaille 17 Mohan Shenoy 23 Manish Sinha 24 Colette Smith 22 Enrico Vidal 21 Karel Vondrak 20 Alev Yilmaz 19 Michel Fischbach 18 Claus Schmitt 5 Franz Schaefer 5

1- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
2- Cukurova University, Adana, Turkey
3- A & P Kyriakou Children’s Hospital, Athens, Greece
4- Cerrahpasa School of Medicine, Istanbul, Turkey
5- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
6- Cerrahpasa School of Medicine, Istanbul, Turkey
7- Gazi University Hospital, Ankara, Turkey
8- Hacettepe University, Ankara, Turkey
9- University Hospital Cologne, Cologne, Germany
10- University Hospital of Wales, Cardiff, UK
11- Hôpital Necker-Enfants Malades, Paris, France
12- Hospital for Sick Children, Toronto, Canada
13- Memorial Health Institute, Warsaw, Poland
14- Fondazione Ospedale Maggiore Policlinico, Milano, Italy
15- Unità di Dialisis, Roma, Italy
16- Hôpital Femme Mere Enfant, Lyon, France
17- Hôpital Jeanne De Flandre, Lille, France
18- Dialysis Centre for Children, Strasbourg, France
19- Istanbul University Medical Faculty, Istanbul, Turkey
20- University Hospital Motol, Prague, Czech Republic
21- Dialysis and Transplant Unit, Padova, Italy
22- Royal Free Hospital, London, UK
23- Royal Manchester Children’s Hospital, Manchester, UK
24- Evelina Childrens Hospital, London, UK
 
Introduction:

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.

Material and methods:

We analysed the baseline data in prevalent dialysis patients from the HDF vs HD (3H) study to assess fluid status, BP and cardiovascular measures on HD and HDF.

Results:

Of the 179 children (from 28 centres in 10 European countries) in the HDF vs HD study 69 were prevalent dialysis patients, 35 on HD and 34 on HDF, and are further described here. There was no difference between HD and HDF groups in age, gender, underlying renal disease, dialysis vintage (median 3.4 months), type of vascular access (AVF in 34 vs 29% on HD and HDF), blood flow or presence of residual renal function. On bioimpedance spectroscopy children on HDF were less likely to have fluid overload compared to HD (Rel OH 4.2 vs 9.8%; p=0.016), and had lower 24 hour mean arterial pressure (MAP, 93 vs 87.5 mmHg; p=0.04). Although there was no difference in interdialytic weight gain, children on HDF required fewer rescue sessions (4.1% HDF vs 19.9% HD; p=0.008). The height-adjusted pulse wave velocity-SDS was lower in HDF vs HD (0.09 vs 1.33; p<0.0001) and correlated positively with MAP, ultrafiltration and the blood flow rate. HDF patients had a lower left ventricular mass index (30.7 vs 43.5; p=0.001). Incident dialysis patients from the same centre did not demonstrate a difference in Rel OH status or MAP between HD and HDF groups, suggesting that centre bias is unlikely and dialysis modality significantly influences the fluid status.

Conclusions:

Children on HDF have improved fluid control and cardiovascular measures compared to those on HD, and this effect is seen even with a short dialysis vintage of 3.4 months.