Haemodiafiltration use in children: data from the Italian Pediatric Dialysis Registry
High volume haemodiafiltration (HDF) is associated with better survival than conventional haemodialysis (HD) in adults, but data concerning its use in children are lacking. The aim of this study was to assess the prevalence of paediatric HDF use and its associated factors in recent years in Italy.
We retrospectively reviewed the files of patients from the Italian Pediatric Dialysis Registry’s database who were registered between January 1, 2004 and December 31, 2016 and treated with extracorporeal dialysis for at least 6 months, looking in particular at modality and its associated factors.
One hundred forty-one out of 198 patients were treated exclusively with bicarbonate HD (71.2%), 57 with HDF (28.8%). Patients treated with HDF were younger (median 9.7 vs 13.2 years, p = 0.0008), were less often incident patients (52.6% vs 75.9%, p = 0.0031), had longer duration of the HD cycle (26.9 vs 20.8 months, p = 0.0036) and had a longer time to renal transplantation (32 vs 25 months, p = 0.0029) than those treated with bicarbonate HD only. The percentage of patients treated with HDF increased with dialysis vintage (16.9% at 6 months, 38.1% after more than 2 years of dialysis). The use of HDF was stable over time and was more common in the largest centres.
Over the observation period, HDF use in Italy has been limited to roughly a quarter of patients on extracorporeal dialysis, in particular to those with high dialysis vintage, younger age or a long expected waiting time to renal transplantation.
KeywordsExtracorporeal dialysis Children Paediatric dialysis Haemodiafiltration Haemodialysis
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.US Renal Data System: USRDS 2015 Annual Data Report (2015) Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney DiseasesGoogle Scholar
- 6.Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R, Hemodialysis (HEMO) Study Group (2002) Effect of dialysis dose and membrane flux in maintenance haemodialysis. N Engl J Med 347:2010–2019CrossRefPubMedGoogle Scholar
- 7.Perl J, Dember LM, Bargman JM, Browne T, Charytan DM, Flythe JE, Hickson LJ, Hung AM, Jadoul M, Lee TC, Meyer KB, Moradi H, Shafi T, Teitelbaum I, Wong LP, Chan CT, American Society of Nephrology Dialysis Advisory Group (2017) The use of a multidimensional measure of dialysis adequacy-moving beyond small solute kinetics. Clin J Am Soc Nephrol 12:839–847CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Grooteman MP, van den Dorpel MA, Bots ML, Penne EL, van der Weerd NC, Mazairac AH, den Hoedt CH, van der Tweel I, Lévesque R, Nubé MJ, ter Wee PM, Blankestijn PJ, CONTRAST Investigators (2012) Effect of online haemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol 23:1087–1096CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Ok E, Asci G, Toz H, Ok ES, Kircelli F, Yilmaz M, Hur E, Demirci MS, Demirci C, Duman S, Basci A, Adam SM, Isik IO, Zengin M, Suleymanlar G, Yilmaz ME, Ozkahya M, Turkish Online Haemodiafiltration Study (2013) Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF study. Nephrol Dial Transplant 28:192–202CrossRefPubMedGoogle Scholar
- 13.Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, Carreras J, Soler J, Torres F, Campistol JM, Martinez-Castelao A, ESHOL Study Group (2013) High-efficiency postdilution online haemodiafiltration reduces all-cause mortality in haemodialysis patients. J Am Soc Nephrol 24:487–497CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Wang AY, Ninomiya T, Al-Kahwa A, Perkovic V, Gallagher MP, Hawley C, Jardine MJ (2014) Effect of hemodiafiltration or hemofiltration compared with hemodialysis on mortality and cardiovascular disease in chronic kidney failure: a systematic review and meta-analysis of randomized trials. Am J Kidney Dis 63:968–978CrossRefPubMedGoogle Scholar
- 18.Peters SA, Bots ML, Canaud B, Davenport A, Grooteman MP, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ, HDF Pooling Project Investigators (2016) Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials. Nephrol Dial Transplant 31:978–984CrossRefPubMedGoogle Scholar
- 25.Ağbaş A, Canpolat N, Çalışkan S, Yılmaz A, Ekmekçi H, Mayes M, Aitkenhead H, Schaefer F, Sever L, Shroff R (2018) Haemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux haemodialysis in children. PLoS One 13:e0198320CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Shroff R, Bayazit A, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Agbas A, Anarat A, Aoun B, Bakkaloglu S, Bhowruth D, Borzych-Dużałka D, Bulut IK, Büscher R, Dempster C, Duzova A, Habbig S, Hayes W, Hegde S, Krid S, Licht C, Litwin M, Mayes M, Mir S, Nemec R, Obrycki L, Paglialonga F, Picca S, Ranchin B, Samaille C, Shenoy M, Sinha M, Smith C, Spasojevic B, Vidal E, Vondrák K, Yilmaz A, Zaloszyc A, Fischbach M, Schaefer F, Schmitt CP (2018) Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children—the HDF, heart and height (3H) study. BMC Nephrol 19:199CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Shroff R, Bayazit A, Stefanidis C, Askiti V, Azukaitis K, Canpolat N, Bakkaloglu S (2017) Haemodiafiltration (HDF) is associated with superior fluid control and reduced cardiovascular risk profile compared to conventional haemodialysis (HD)—data from the HDF vs HD (3H) study. Pediatr Nephrol 32:1730Google Scholar
- 29.Cheung AK, Rocco MV, Yan G, Leypoldt JK, Levin NW, Greene T, Agodoa L, Bailey J, Beck GJ, Clark W, Levey AS, Ornt DB, Schulman G, Schwab S, Teehan B, Eknoyan G (2006) Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study. J Am Soc Nephrol 17:546–555CrossRefPubMedGoogle Scholar
- 30.Penne EL, van der Weerd NC, Blankestijn PJ, van den Dorpel MA, Grooteman MP, Nubé MJ, Ter Wee PM, Lévesque R, Bots ML, investigators CONTRAST (2010) Role of residual kidney function and convective volume on change in beta2-microglobulin levels in haemodiafiltration patients. Clin J Am Soc Nephrol 5:80–86CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Penne EL, van der Weerd NC, van den Dorpel MA, Grooteman MP, Lévesque R, Nubé MJ, Bots ML, Blankestijn PJ, ter Wee PM, CONTRAST Investigators (2010) Short-term effects of online haemodiafiltration on phosphate control: a result from the randomized controlled Convective Transport Study (CONTRAST). Am J Kidney Dis 55:77–87CrossRefPubMedGoogle Scholar
- 33.Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini LA, Basile C, David S, Feriani M, Montagna G, Di Iorio BR, Memoli B, Cravero R, Battaglia G, Zoccali C (2010) Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD. J Am Soc Nephrol 21:1798–1807CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Shroff R, Fischbach M, Schaefer F, Edefonti A, Schmitt C, on behalf of the 4c Study Consortium (2014) Paediatric dialysis practice across the EU. Pediatr Nephrol 29:1667Google Scholar