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

被引：16

作者：

Fischer, Dagmar-Christiane ^{[1
]}

Smith, Colette ^{[2
]}

De Zan, Francesca ^{[3
]}

Bacchetta, Justine ^{[4
]}

Bakkaloglu, Sevcan A. ^{[5
]}

Agbas, Ayse ^{[6
]}

Anarat, Ali ^{[7
]}

Aoun, Bilal ^{[8
]}

Askiti, Varvara ^{[9
]}

Azukaitis, Karolis ^{[10
]}

Bayazit, Aysun ^{[7
]}

Bulut, Ipek Kaplan ^{[11
]}

Canpolat, Nur ^{[6
]}

Borzych-Duzalka, Dagmara ^{[12
]}

Duzova, Ali ^{[13
]}

Habbig, Sandra ^{[14
]}

Krid, Saoussen ^{[15
]}

Licht, Christoph ^{[16
]}

Litwin, Mieczyslaw ^{[17
]}

Obrycki, Lukasz ^{[17
]}

Paglialonga, Fabio ^{[18
]}

Rahn, Anja ^{[1
]}

Ranchin, Bruno ^{[4
]}

Samaille, Charlotte ^{[19
]}

Shenoy, Mohan ^{[20
]}

Sinha, Manish D. ^{[21
]}

Spasojevic, Brankica ^{[22
]}

Stefanidis, Constantinos J. ^{[9
]}

Vidal, Enrico ^{[23
]}

Yilmaz, Alev ^{[24
]}

Fischbach, Michel ^{[25
,26
]}

Schaefer, Franz ^{[26
]}

Schmitt, Claus Peter

Shroff, Rukshana ^{[3
]}

机构：

[1] Rostock Univ Med Ctr, Dept Pediat, Rostock, Germany

[2] UCL, Inst Global Hlth, Pediat Nephrol Unit, London, England

[3] UCL, Pediat Nephrol Unit, Great Ormond St Hosp, Children & Inst Child Hlth, London, England

[4] Univ Lyon, Hosp Civils Lyon, Pediat Nephrol Unit, Hop Femme Mere Enfant, Bron, France

[5] Gazi Univ Hosp, Pediat Nephrol Unit, Ankara, Turkey

[6] Cerrahpasa Med Sch, Pediat Nephrol Unit, Istanbul, Turkey

[7] Cukurova Univ, Pediat Nephrol Unit, Adana, Turkey

[8] Armand Trousseau Hosp, Pediat Nephrol Unit, Paris, France

[9] Panagiotis & Aglaia Kyriakou Childrens Hosp, Pediat Nephrol Unit, Athens, Greece

[10] Vilnius Univ, Clin Pediat, Fac Med, Pediat Nephrol Unit, Vilnius, Lithuania

[11] Ege Univ Fac Med, Pediat Nephrol Unit, Izmir, Turkey

[12] Ege Univ, Pediat Nephrol Unit, Fac Med, Izmir, Turkey

[13] Med Univ Gdansk, Pediat Nephrol Unit, Gdansk, Poland

[14] Hacettepe Univ, Pediat Nephrol Unit, Ankara, Turkey

[15] Univ Hosp Cologne, Pediat Nephrol Unit, Cologne, Germany

[16] Hop Necker Enfants Malad, Pediatr Nephrol Unit, Paris, France

[17] Hosp Sick Children, Pediat Nephrol Unit, Toronto, ON, Canada

[18] Childrens Mem Hlth Inst, Pediat Nephrol Unit, Warsaw, Poland

[19] Pediat Nephrol Unit, Fdn Ist Ricovero Cura Carattere Scientifi, Granda Osped Maggiore Policlin, Milan, Italy

[20] Ctr Hosp Univ Lille, Serv Nephrol Pediatr, Lille, France

[21] Royal Manchester Childrens Hosp, Pediat Nephrol Unit, Manchester, England

[22] London Childrens Hosp, Pediat Nephrol Unit, Kings Coll London Evelina, London, England

[23] Univ Childrens Hosp, Pediat Nephrol Unit, Belgrade, Serbia

[24] Univ Udine, Dept Med, Div Pediat, Udine, Italy

[25] Istanbul Univ, Pediat Nephrol Unit, Fac Med, Istanbul, Turkey

[26] Childrens Dialysis Ctr, Strasbourg, France

来源：

KIDNEY INTERNATIONAL REPORTS | 2021年 / 6卷 / 09期

关键词：

hemodiafiltration; hemodialysis; inflammation; mineral bone disease; pediatric nephrology; CHRONIC KIDNEY-DISEASE; GROWTH-FACTOR; 23; LEFT-VENTRICULAR HYPERTROPHY; TNF-ALPHA; ONLINE HEMODIAFILTRATION; CLINICAL-PRACTICE; VASCULAR CALCIFICATION; SYSTEMIC INFLAMMATION; ALKALINE-PHOSPHATASE; BIOCHEMICAL MARKERS;

D O I：

10.1016/j.ekir.2021.06.025

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Patients on dialysis have a high burden of bone-related comorbidities, including fractures. We report a post hoc analysis of the prospective cohort study HDF, Hearts and Heights (3H) to determine the prevalence and risk factors for chronic kidney disease-related bone disease in children on hemodiafiltration (HDF) and conventional hemodialysis (HD). Methods: The baseline cross-sectional analysis included 144 children, of which 103 (61 HD, 42 HDF) completed 12-month follow-up. Circulating biomarkers of bone formation and resorption, inflammatory markers, fibroblast growth factor-23, and klotho were measured. Results: Inflammatory markers interleukin-6, tumor necrosis factor-alpha, and high-sensitivity C-reactive protein were lower in HDF than in HD cohorts at baseline and at 12 months (P < .001). Concentrations of bone formation (bone-specific alkaline phosphatase) and resorption (tartrate-resistant acid phosphatase 5b) markers were comparable between cohorts at baseline, but after 12-months the bone-specific alkaline phosphatase/tartrate-resistant acid phosphatase 5b ratio increased in HDF (P = .004) and was unchanged in HD (P = .44). On adjusted analysis, the bone-specific alkaline phosphatase/tartrate-resistant acid phosphatase 5b ratio was 2.66-fold lower (95% confidence interval, -3.91 to -1.41; P < .0001) in HD compared with HDF. Fibroblast growth factor-23 was comparable between groups at baseline (P = .52) but increased in HD (P < .0001) and remained unchanged in HDF (P = .34) at 12 months. Klotho levels were similar between groups and unchanged during follow-up. The fibroblast growth factor-23/klotho ratio was 3.86-fold higher (95% confidence interval, 2.15-6.93; P < .0001) after 12 months of HD compared with HDF. Conclusion: Children on HDF have an attenuated inflammatory profile, increased bone formation, and lower fibroblast growth factor-23/klotho ratios compared with those on HD. Long-term studies are required to determine the effects of an improved bone biomarker profile on fracture risk and cardiovascular health.

引用

页码：2358 / 2370

页数：13

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