ESPN 50th Annual Meeting

ESPN 2017


 
Effects of haemodiafiltration (HDF) vs conventional haemodialysis (HD) on growth and cardiovascular markers in children – data from the HDF vs HD (3H) study
RUKSHANA SHROFF 1 Aysun Bayazit 2 Constantinos Stefanidis 3 Varvara Askiti 3 Karolis Ažukaitis 4 Nur Canpolat 5 Salim Çaliskan 5 Bilal Anon 6 Sevcan Bakkaloglu 7 Dagmara Borzych-Dużałka 4 Ali Duzova 8 Sandra Habbig 9 Wesley Hayes 1 Shivram Hegde 10 Saoussen Krid 11 Christoph Licht 12 Mieczyslav Litwin 13 Mark Mayes 1 Fabio Paglialonga 14 Stefano Picca 15 Bruno Ranchin 17 Charlotte Samaille 16 Mohan Shenoy 19 Manish Sinha 18 Colette Smith 21 Brankica Spasojevic 20 Enrico Vidal 22 Karel Vondrák 23 Alev Yilmaz 24 Michel Fischbach 25 Franz Schaefer 4 Claus Schmitt 4

1- GREAT ORMOND STREET HOSPITAL FOR CHILDREN, LONDON, UK
2- Cukurova University, Adana, Turkey
3- A & P Kyriakou Children’s Hospital, Athens, Greece
4- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
5- Cerrahpasa School of Medicine, Istanbul, Turkey
6- Armand Trousseau Hospital, Paris, France
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- Childrens Memorial Health Institute, Warsaw, Poland
14- Fondazione Ospedale Maggiore Policlinico, Milano, Italy
15- Unità di Dialisis, Roma, Italy
16- Hôpital Jeanne De Flandre, Lille, France
17- Hôpital Femme Mere Enfant, Lyon, France
18- Evelina Childrens Hospital, London, UK
19- Royal Manchester Childrens Hospital, Manchester, UK
20- University Childrens Hospital, Belgrade, Serbia
21- Royal Free Hospital, London, UK
22- Dialysis and Transplant Unit, Padova, Italy
23- University Hospital Motol, Prague, Czech Republic
24- Istanbul University Medical Faculty, Istanbul, Turkey
25- Childrens Dialysis Center, Strasbourg, France
 
Introduction:

Randomised trials in adults suggest that HDF with high convective volumes is associated with reduced cardiovascular mortality. Also, a single centre study has shown improved growth in children on HDF.

Material and methods:

We performed a prospective longitudinal study in children on HDF vs conventional HD to determine annualised change in cardiovascular end-points and growth and to determine factors related to dialysis therapy that may improve outcomes.

Results:

179 children (106 on HD and 73 on HDF) were recruited from 28 centres in 10 European countries. There was no difference in age, underlying diagnosis, previous dialysis therapy, dialysis vintage, residual renal function, type of vascular access (AVF in 34 vs 29% on HD and HDF) or blood flow between HD and HDF groups. High flux dialysers and machines with HDF capability were used even in a significant proportion of HD patients (38% and 76% respectively), but ultra-pure water was available only in 57% of HD patients (p<0.0001). HDF patients achieved a median convective volume of 13.3L/m2; this was significantly influenced by blood flow only, and independent of vascular access type. At baseline, HDF patients were taller (height SDS -1.39 vs -2.21; p=0.0005), and had a higher Kt/V and urea reduction rate. On further assessment of the prevalent dialysis patients (35 on HD and 34 on HDF), HDF patients had a higher haemoglobin and albumin and lower serum phosphate compared to HD patients (p=0.04, p=0.02 and p=0.01 respectively). Serum bicarbonate <18mMol/L was more common in HD than HDF patients (p=0.03). Differences in serum phosphate and bicarbonate persisted after adjusting for centre bias.

Conclusions:

This is the largest prospective cohort study on dialysis outcomes in children. At baseline analysis prevalent patients on HDF had significantly lower serum phosphate levels and were less likely to have metabolic acidosis than those on HD.