Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, United Kingdom and
Vascular Physiology Unit, University College London Institute of Child Health, Gower Street, London, United Kingdom.
J Am Soc Nephrol. 2019 Apr;30(4):678-691. doi: 10.1681/ASN.2018100990. Epub 2019 Mar 7.
Hypertension and cardiovascular disease are common in children undergoing dialysis. Studies suggest that hemodiafiltration (HDF) may reduce cardiovascular mortality in adults, but data for children are scarce.
The HDF, Heart and Height study is a nonrandomized observational study comparing outcomes on conventional hemodialysis (HD) versus postdilution online HDF in children. Primary outcome measures were annualized changes in carotid intima-media thickness (cIMT) SD score and height SD score.
We enrolled 190 children from 28 centers; 78 on HD and 55 on HDF completed 1-year follow-up. The groups were comparable for age, dialysis vintage, access type, dialysis frequency, blood flow, and residual renal function. At 1 year, cIMT SD score increased significantly in children on HD but remained static in the HDF cohort. On propensity score analysis, HD was associated with a +0.47 higher annualized cIMT SD score compared with HDF. Height SD score increased in HDF but remained static in HD. Mean arterial pressure SD score increased with HD only. Factors associated with higher cIMT and mean arterial pressure SD-scores were HD group, higher ultrafiltration rate, and higher 2-microglobulin. The HDF cohort had lower 2-microglobulin, parathyroid hormone, and high-sensitivity C-reactive protein at 1 year; fewer headaches, dizziness, or cramps; and shorter postdialysis recovery time.
HDF is associated with a lack of progression in vascular measures versus progression with HD, as well as an increase in height not seen in the HD cohort. Patient-related outcomes improved among children on HDF correlating with improved BP control and clearances. Confirmation through randomized trials is required.
高血压和心血管疾病在接受透析的儿童中很常见。研究表明，血液透析滤过（HDF）可能降低成人的心血管死亡率，但儿童的数据很少。
HDF、心脏和身高研究是一项非随机观察性研究，比较了常规血液透析（HD）与儿童在线后稀释 HDF 的结果。主要观察指标为颈动脉内膜中层厚度（cIMT）SD 评分和身高 SD 评分的年变化率。
我们从 28 个中心纳入了 190 名儿童；78 名在 HD 组，55 名在 HDF 组完成了 1 年的随访。两组在年龄、透析龄、通路类型、透析频率、血流量和残余肾功能方面具有可比性。在 1 年时，HD 组的 cIMT SD 评分显著增加，而 HDF 组则保持稳定。在倾向评分分析中，HD 组与 HDF 组相比，每年 cIMT SD 评分增加 0.47。HDF 组的身高 SD 评分增加，而 HD 组则保持稳定。只有 HD 组的平均动脉压 SD 评分增加。与 cIMT 和平均动脉压 SD 评分升高相关的因素是 HD 组、超滤率较高和 2-微球蛋白较高。与 1 年时的 HDF 组相比，HD 组的 2-微球蛋白、甲状旁腺激素和高敏 C 反应蛋白较低，头痛、头晕或痉挛较少，透析后恢复时间较短。
与 HD 相比，HDF 与血管指标的进展无关，与 HD 组相比，身高增加，而 HD 组的身高没有增加。HDF 组的患者相关结局得到改善，这与血压控制和清除率的改善有关。需要通过随机试验来证实。
