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Hemodiafiltration may serve as positive alternative to hemodialysis for children with ESKD
For children with ESKD, hemodiafiltration was associated with a lack of progression in vascular measures, an increase in height and improved outcomes when compared with conventional hemodialysis, according to a study published in Journal of the American Society of Nephrology.
“Hemodiafiltration is a safe and effective treatment in children that may reduce their cardiovascular risk burden, improve the clearance of toxic middle molecular weight compounds and improve growth compared to conventional hemodialysis,” Rukshana Shroff, MD, FRCPCH, PhD, of the nephrology unit at Great Ormond Street Hospital for Children NHS Foundation Trust and the vascular physiology unit at University College London Institute of Child Health in the U.K., told Healio/Nephrology. “Children on hemodiafiltration feel better, with fewer headaches and episodes of dizziness or cramps than children on hemodialysis, which results in better school attendance and greater physical activity.”
To compare outcomes of children on hemodialysis vs. those on postdilution online hemodiafiltration, researchers enrolled 133 children aged between 5 and 20 years (78 on hemodialysis, 55 on hemodiafiltration) from 28 centers in a nonrandomized observational study referred to as the HDF, Heart and Height Study.
Children in both groups were comparable in age, dialysis vintage, access type, dialysis frequency, blood flow and residual renal function.
Patients were followed for 1 year with researchers annually performing imaging studies (carotid intima-media thickness, pulse wave velocity and echocardiogram) and 24-hour ambulatory blood pressure monitoring for mean arterial pressure. In addition, every 6 months, researchers assessed anthropometric and biochemical measures and health-related quality-of-life questionnaires.
The study’s primary outcome measures were annualized changes in carotid intima-media thickness SD score and height SD score.
Researchers found that, at 1 year, carotid intima-media thickness SD score increased in children on hemodialysis but remained static in children on hemodiafiltration and that hemodialysis was associated with a 0.47 higher annualized carotid intima-media thickness SD score than hemodiafiltration.
Researchers also found that height SD score increased only in the hemodiafiltration group while mean arterial pressure SD score increased only in the hemodialysis group.
Additionally, children on hemodiafiltration had lower beta-2-microglobulin, parathyroid hormone and high-sensitivity C-reactive protein, along with fewer headaches and cramps, less dizziness and shorter post-dialysis recovery time than children on hemodialysis.
“For patients on in-center dialysis, with equivalent dialysis-durations and blood flow rates, hemodiafiltration appears to be a more effective dialysis modality,” Shroff said. “Although technically challenging, a randomized trial is required before hemodiafiltration can be considered the ‘standard of care’ for children on in-center dialysis.” – by Melissa J. Webb
Disclosures: Shroff and one other study author report speaker honoraria from Fresenius Medical Care and Amgen.