Hemodiafiltration Is Associated With Reduced Inflammation and Increased Bone Formation Compared With Conventional Hemodialysis in Children: The HDF, Hearts and Heights (3H) Study

Abstract

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Hemodiafiltration in the pediatric population

“…The 3H trial showed that inflammatory cytokines such as IL-6, TNF-α, and high sensitivity CRP were higher in HD compared to HDF patients at baseline and continued to increase significantly in HD, but no change was seen in the HDF cohort over the follow-up period of up to 1 year. 4,9,10 Similar findings were shown in the SWITCH study: When patients on HD were "switched" to HDF keeping all other dialysis related parameters unchanged, a significant reduction in several markers of inflammation, oxidative stress, and endothelial dysfunction was seen after just 3 months on HDF. 9 4.…”

“…The 3H study investigated bone‐specific alkaline phosphatase (BAP) a marker of bone formation and tartrate‐resistant acid phosphatase 5b (TRAP5b), a bone resorption marker. The BAP‐to‐TRAP5b activity remained almost constant in children on HD, while children on HDF had an increase in the BAP/TRAP ratio that was comparable to levels seen in healthy children, implying an osteoanabolic process 10 . Fibroblast growth factor 23, also a middle molecular weight substance, is effectively cleared by HDF with levels decreasing by 25% in HDF over the 1‐year follow‐up but increasing by over 100% in children on HD 10 .…”

“…The BAP-to-TRAP5b activity remained almost constant in children on HD, while children on HDF had an increase in the BAP/TRAP ratio that was comparable to levels seen in healthy children, implying an osteoanabolic process. 10 Fibroblast growth factor 23, also a middle molecular weight substance, is effectively cleared by HDF with levels decreasing by 25% in HDF over the 1-year follow-up but increasing by over 100% in children on HD. 10 A significant and consistent lowering of FGF23 by HDF may partially explain the lower left ventricular mass in the 3H cohort 4 and reduced cardiovascular mortality in adults on HDF compared to those on conventional HD.…”

“…10 Fibroblast growth factor 23, also a middle molecular weight substance, is effectively cleared by HDF with levels decreasing by 25% in HDF over the 1-year follow-up but increasing by over 100% in children on HD. 10 A significant and consistent lowering of FGF23 by HDF may partially explain the lower left ventricular mass in the 3H cohort 4 and reduced cardiovascular mortality in adults on HDF compared to those on conventional HD. 2 In earlier studies, Fischbach et al showed that intensified HDF promotes impressive catch-up growth.…”

Muscle Wasting in Chronic Kidney Disease: Mechanism and Clinical Implications—A Narrative Review

“…Hemodiafiltration (HDF) has potential to improve chronic-inflammation by enhancing clearance of medium-high molecular weight solutes through combination of diffusion and convection. The clinical trials indicated HDF improved the inflammatory cachexia and increased bone formation in children [ 126 , 127 ], and reduced inflammation in adult chronic HD patients [ 128 ].…”