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Nutritional and Anthropometric Indices in Children Receiving Haemodiafiltration vs Conventional Haemodialysis - The HDF, Heart and Height (3H) Study

      Background

      The “HDF-Heart-Height” study showed that haemodiafiltration (HDF) is associated with improved growth compared to conventional haemodialysis (HD). We report a post-hoc analysis of this study assessing the effect of extracorporeal dialysis therapies on nutritional indices.

      Methods

      107 children were included in the baseline cross-sectional analysis, of whom 79 (43 HD, 36 HDF) completed the 12-month follow-up. Height (Ht), optimal ‘dry’ weight (Wt), and body mass index (BMI) standard deviations scores (SDS), waist-to-hip ratio, des-acyl ghrelin (DAG), adiponectin, leptin, insulin-like growth factor-1 (IGF-1)-SDS and insulin were measured.

      Results

      The levels of nutritional indices were comparable between HDF and HD patients at baseline and 12-month. On univariable analyses Wt-SDS positively correlated with leptin and IGF-1-SDS, and negatively with DAG, while Ht-SDS of the overall cohort positively correlated with IGF1-SDS and inversely with DAG and adiponectin. On multivariable analyses, higher 12-month Ht-SDS was inversely associated with baseline DAG (beta = −0.13 per 500 higher; 95%CI −0.22, −0.04; P = .004). Higher Wt-SDS at 12-month was positively associated with HDF modality (beta = 0.47 vs HD; 95%CI 0.12-0.83; P = .01) and inversely with baseline DAG (beta = −0.18 per 500 higher; 95%CI −0.32, -0.05; P = .006). Growth Hormone (GH) treated patients receiving HDF had higher annualized increase in Ht SDS compared to those on HD.

      Conclusions

      In children on HD and HDF both Wt- and Ht-SDS independently correlated with lower baseline levels of the anorexygenic hormone DAG. HDF may attenuate the resistance to GH, but further studies are required to examine the mechanisms linking HDF to improved growth.

      Keywords

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      References

        • Bonthuis M.
        • Harambat J.
        • Jager K.J.
        • Vidal E.
        Growth in children on kidney replacement therapy: a review of data from patient registries.
        Pediatr Nephrol. 2021; 36: 2563-2574
        • Oliveira E.A.
        • Cheung W.W.
        • Toma K.G.
        • Mak R.H.
        Muscle wasting in chronic kidney disease.
        Pediatr Nephrol. 2018; 33: 789-798
        • Silverstein D.M.
        Growth and nutrition in pediatric chronic kidney disease.
        Front Pediatr. 2018; 6: 205
        • Arbeiter A.K.
        • Buscher R.
        • Petersenn S.
        • Hauffa B.P.
        • Mann K.
        • Hoyer P.F.
        Ghrelin and other appetite-regulating hormones in paediatric patients with chronic renal failure during dialysis and following kidney transplantation.
        Nephrol Dial Transpl. 2009; 24: 643-646
        • Canpolat N.
        • Sever L.
        • Agbas A.
        • et al.
        Leptin and ghrelin in chronic kidney disease: their associations with protein-energy wasting.
        Pediatr Nephrol. 2018; 33: 2113-2122
        • Monzani A.
        • Perrone M.
        • Prodam F.
        • et al.
        Unacylated ghrelin and obestatin: promising biomarkers of protein energy wasting in children with chronic kidney disease.
        Pediatr Nephrol. 2018; 33: 661-672
        • Przybycinski J.
        • Dziedziejko V.
        • Puchalowicz K.
        • Domanski L.
        • Pawlik A.
        Adiponectin in chronic kidney disease.
        Int J Mol Sci. 2020; 21
        • Teta D.
        Adipokines as uremic toxins.
        J Ren Nutr. 2012; 22: 81-85
        • Brown D.D.
        • Dauber A.
        Growth hormone and insulin-like growth factor Dysregulation in pediatric chronic kidney disease.
        Horm Res Paediatr. 2021; 94: 105-114
        • Schaefer F.
        Daily online haemodiafiltration: the perfect 'stimulus package' to induce growth?.
        Nephrol Dial Transpl. 2010; 25: 658-660
        • Tattersall J.E.
        • Ward R.A.
        • group E.
        Online haemodiafiltration: definition, dose quantification and safety revisited.
        Nephrol Dial Transpl. 2013; 28: 542-550
        • Maduell F.
        • Moreso F.
        • Pons M.
        • et al.
        High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients.
        J Am Soc Nephrol. 2013; 24: 487-497
        • Peters S.A.
        • Bots M.L.
        • Canaud B.
        • et al.
        Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials.
        Nephrol Dial Transpl. 2016; 31: 978-984
        • Grooteman M.P.
        • van den Dorpel M.A.
        • Bots M.L.
        • et al.
        Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes.
        J Am Soc Nephrol. 2012; 23: 1087-1096
        • Ok E.
        • Asci G.
        • Toz H.
        • et al.
        Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study.
        Nephrol Dial Transpl. 2013; 28: 192-202
        • Mostovaya I.M.
        • Grooteman M.P.
        • Basile C.
        • et al.
        High convection volume in online post-dilution haemodiafiltration: relevance, safety and costs.
        Clin Kidney J. 2015; 8: 368-373
        • Fischbach M.
        • Terzic J.
        • Laugel V.
        • et al.
        Daily on-line haemodiafiltration: a pilot trial in children.
        Nephrol Dial Transpl. 2004; 19: 2360-2367
        • Fischbach M.
        • Terzic J.
        • Menouer S.
        • Dheu C.
        • Seuge L.
        • Zalosczic A.
        Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis.
        Nephrol Dial Transpl. 2010; 25: 867-873
        • Thumfart J.
        • Puttkamer C.V.
        • Wagner S.
        • Querfeld U.
        • Muller D.
        Hemodiafiltration in a pediatric nocturnal dialysis program.
        Pediatr Nephrol. 2014; 29: 1411-1416
        • Agbas A.
        • Canpolat N.
        • Caliskan S.
        • et al.
        Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children.
        PLoS One. 2018; 13: e0198320
        • Shroff R.
        • Bayazit A.
        • Stefanidis C.J.
        • et al.
        Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children - the HDF, heart and height (3H) study.
        BMC Nephrol. 2018; 19: 199
        • Shroff R.
        • Smith C.
        • Ranchin B.
        • et al.
        Effects of hemodiafiltration versus conventional hemodialysis in children with ESKD: the HDF, heart and height study.
        J Am Soc Nephrol. 2019; 30: 678-691
        • Alberti C.
        • Chevenne D.
        • Mercat I.
        • et al.
        Serum concentrations of insulin-like growth factor (IGF)-1 and IGF binding protein-3 (IGFBP-3), IGF-1/IGFBP-3 ratio, and markers of bone turnover: reference values for French children and adolescents and z-score comparability with other references.
        Clin Chem. 2011; 57: 1424-1435
        • Ricotti R.
        • Genoni G.
        • Giglione E.
        • et al.
        High-normal estimated glomerular filtration rate and hyperuricemia positively correlate with metabolic impairment in pediatric obese patients.
        PLoS One. 2018; 13: e0193755
        • Susantitaphong P.
        • Siribamrungwong M.
        • Jaber B.L.
        Convective therapies versus low-flux hemodialysis for chronic kidney failure: a meta-analysis of randomized controlled trials.
        Nephrol Dial Transpl. 2013; 28: 2859-2874
        • Szczepanska M.
        • Szprynger K.
        • Mazur B.
        • Zwolinska D.
        • Kilis-Pstrusinska K.
        • Makulska I.
        Plasma ghrelin levels in children with chronic renal failure on peritoneal dialysis.
        Perit Dial Int. 2007; 27: 61-66
        • Gupta R.K.
        • Kuppusamy T.
        • Patrie J.T.
        • et al.
        Association of plasma des-acyl ghrelin levels with CKD.
        Clin J Am Soc Nephrol. 2013; 8: 1098-1105
        • Perez-Fontan M.
        • Cordido F.
        • Rodriguez-Carmona A.
        • Peteiro J.
        • Garcia-Naveiro R.
        • Garcia-Buela J.
        Plasma ghrelin levels in patients undergoing haemodialysis and peritoneal dialysis.
        Nephrol Dial Transpl. 2004; 19: 2095-2100
        • Mandolfo S.
        • Borlandelli S.
        • Imbasciati E.
        Leptin and beta2-microglobulin kinetics with three different dialysis modalities.
        Int J Artif Organs. 2006; 29: 949-955
        • Beerenhout C.H.
        • Luik A.J.
        • Jeuken-Mertens S.G.
        • et al.
        Pre-dilution on-line haemofiltration vs low-flux haemodialysis: a randomized prospective study.
        Nephrol Dial Transpl. 2005; 20: 1155-1163
        • Snauwaert E.
        • Van Biesen W.
        • Raes A.
        • et al.
        Haemodiafiltration does not lower protein-bound uraemic toxin levels compared with haemodialysis in a paediatric population.
        Nephrol Dial Transpl. 2020; 35: 648-656
        • D'Marco L.
        • Puchades M.J.
        • Gorriz J.L.
        • et al.
        Epicardial adipose tissue, adiponectin and leptin: a potential source of cardiovascular risk in chronic kidney disease.
        Int J Mol Sci. 2020; 21
        • Kamariski M.
        • Biscardi M.
        • Cestino L.
        • Miatello R.
        • Guntsche E.
        • Valles P.G.
        Adiponectin in children on peritoneal dialysis: relationship to insulin resistance and nutritional status.
        Nephron Clin Pract. 2009; 113: c24-c32
        • Maggio M.C.
        • Montaperto D.
        • Maringhini S.
        • Corrado C.
        • Gucciardino E.
        • Corsello G.
        Adiponectin, resistin and leptin in paediatric chronic renal failure: correlation with auxological and endocrine profiles.
        J Nephrol. 2014; 27: 275-279
        • Moller K.F.
        • Dieterman C.
        • Herich L.
        • Klaassen I.A.
        • Kemper M.J.
        • Muller-Wiefel D.E.
        High serum adiponectin concentration in children with chronic kidney disease.
        Pediatr Nephrol. 2012; 27: 243-249
        • Szczepanska M.
        • Machura E.
        • Adamczyk P.
        • et al.
        Evaluation of adipocytokines in children with chronic kidney disease.
        Endokrynol Pol. 2015; 66: 100-107
        • Rhee C.M.
        • Nguyen D.V.
        • Moradi H.
        • et al.
        Association of adiponectin with body composition and mortality in hemodialysis patients.
        Am J Kidney Dis. 2015; 66: 313-321
        • Adamczak M.
        • Chudek J.
        • Wiecek A.
        Adiponectin in patients with chronic kidney disease.
        Semin Dial. 2009; 22: 391-395
        • Huang J.W.
        • Yen C.J.
        • Chiang H.W.
        • Hung K.Y.
        • Tsai T.J.
        • Wu K.D.
        Adiponectin in peritoneal dialysis patients: a comparison with hemodialysis patients and subjects with normal renal function.
        Am J Kidney Dis. 2004; 43: 1047-1055
        • Mahesh S.
        • Kaskel F.
        Growth hormone axis in chronic kidney disease.
        Pediatr Nephrol. 2008; 23: 41-48
        • Besbas N.
        • Ozdemir S.
        • Saatci U.
        • et al.
        Nutritional assessment of children on haemodialysis: value of IGF-I, TNF-alpha and IL-1beta.
        Nephrol Dial Transpl. 1998; 13: 1484-1488
        • Avila-Carrasco L.
        • Pavone M.A.
        • Gonzalez E.
        • et al.
        Abnormalities in glucose metabolism, appetite-related peptide Release, and Pro-inflammatory cytokines play a central role in appetite Disorders in peritoneal dialysis.
        Front Physiol. 2019; 10: 630
        • Kittiskulnam P.
        • Srijaruneruang S.
        • Chulakadabba A.
        • et al.
        Impact of serum bicarbonate levels on muscle mass and kidney function in pre-dialysis chronic kidney disease patients.
        Am J Nephrol. 2020; 51: 24-34
        • Pedrini L.A.
        • De C.V.
        • Pagliari B.
        Effects of the infusion mode on bicarbonate balance in on-line hemodiafiltration.
        Int J Artif Organs. 2002; 25: 100-106
        • Ahrenholz P.
        • Winkler R.E.
        • Ramlow W.
        • Tiess M.
        • Thews O.
        On-line hemodiafiltration with pre- and postdilution: impact on the acid-base status.
        Int J Artif Organs. 1998; 21: 321-327
        • Morel H.
        • Jaffrin M.Y.
        • Lux C.
        • et al.
        A comparison of bicarbonate kinetics and acid-base status in high flux hemodialysis and on-line post-dilution hemodiafiltration.
        Int J Artif Organs. 2012; 35: 288-300
        • Feriani M.
        Acid-base homeostasis with the high convective dialysis treatments.
        Nephrol Dial Transpl. 2003; 18 (discussion vii56-7): vii26-vii30
        • Fischer D.C.
        • Smith C.
        • De Zan F.
        • et al.
        Hemodiafiltration is associated with reduced inflammation and increased bone formation compared with conventional hemodialysis in children: the HDF, Hearts and heights (3H) study.
        Kidney Int Rep. 2021; 6: 2358-2370
        • Pass C.
        • MacRae V.E.
        • Ahmed S.F.
        • Farquharson C.
        Inflammatory cytokines and the GH/IGF-I axis: novel actions on bone growth.
        Cell Biochem Funct. 2009; 27: 119-127
        • Mak R.H.
        Cachexia in children with chronic kidney disease: challenges in diagnosis and treatment.
        Curr Opin Support Palliat Care. 2016; 104: 293-297