Francesca De Zan1, Colette Smith2, Ali Duzova3, Aysun Bayazit4, Constantinos J Stefanidis5, Varvara Askiti5, Karolis Azukaitis6, Nur Canpolat7, Ayse Agbas7, Ali Anarat4, Bilal Aoun8, Sevcan A Bakkaloglu9, Dagmara Borzych-Dużałka10, Ipek Kaplan Bulut11, Sandra Habbig12, Saoussen Krid13, Christoph Licht14, Mieczyslaw Litwin15, Lukasz Obrycki15, Fabio Paglialonga16, Bruno Ranchin17, Charlotte Samaille18, Mohan Shenoy19, Manish D Sinha20, Brankica Spasojevic21, Alev Yilmaz22, Michel Fischbach23, Claus Peter Schmitt24, Franz Schaefer24, Enrico Vidal25, Rukshana Shroff26,27. 1. University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK. 2. Institute of Global Health, University College London, London, UK. 3. Hacettepe University, Ankara, Turkey. 4. Cukurova University, Adana, Turkey. 5. A & P Kyriakou Children's Hospital, Athens, Greece. 6. Clinic of Pediatrics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 7. Cerrahpasa School of Medicine, Istanbul, Turkey. 8. Armand Trousseau Hospital, Paris, France. 9. Gazi University Hospital, Ankara, Turkey. 10. Medical University of Gdańsk, Gdańsk, Poland. 11. Ege University Faculty of Medicine, Izmir, Turkey. 12. University Hospital Cologne, Cologne, Germany. 13. Hôpital Necker-Enfants Malades, Paris, France. 14. The Hospital for Sick Children, Toronto, ON, Canada. 15. Children's Memorial Health Institute, Warsaw, Poland. 16. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 17. Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France. 18. CHU Lille, Service de Néphrologie Pédiatrique, Lille, France. 19. Royal Manchester Children's Hospital, Manchester, UK. 20. Kings College London Evelina London Children's Hospital, London, UK. 21. University Children's Hospital, Belgrade, Serbia. 22. Istanbul University Faculty of Medical, Istanbul, Turkey. 23. Children's Dialysis Center, Strasbourg, France. 24. Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany. 25. Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy. 26. University College London Great Ormond Street Hospital for Children and Institute of Child Health, London, UK. Rukshana.Shroff@gosh.nhs.uk. 27. Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. Rukshana.Shroff@gosh.nhs.uk.
Abstract
BACKGROUND: Hypertension is prevalent in children on dialysis and associated with cardiovascular disease. We studied the blood pressure (BP) trends and the evolution of BP over 1 year in children on conventional hemodialysis (HD) vs. hemodiafiltration (HDF). METHODS: This is a post hoc analysis of the "3H - HDF-Hearts-Height" dataset, a multicenter, parallel-arm observational study. Seventy-eight children on HD and 55 on HDF who had three 24-h ambulatory BP monitoring (ABPM) measures over 1 year were included. Mean arterial pressure (MAP) was calculated and hypertension defined as 24-h MAP standard deviation score (SDS) ≥95th percentile. RESULTS: Poor agreement between pre-dialysis systolic BP-SDS and 24-h MAP was found (mean difference - 0.6; 95% limits of agreement -4.9-3.8). At baseline, 82% on HD and 44% on HDF were hypertensive, with uncontrolled hypertension in 88% vs. 25% respectively; p < 0.001. At 12 months, children on HDF had consistently lower MAP-SDS compared to those on HD (p < 0.001). Over 1-year follow-up, the HD group had mean MAP-SDS increase of +0.98 (95%CI 0.77-1.20; p < 0.0001), whereas the HDF group had a non-significant increase of +0.15 (95%CI -0.10-0.40; p = 0.23). Significant predictors of MAP-SDS were dialysis modality (β = +0.83 [95%CI +0.51 - +1.15] HD vs. HDF, p < 0.0001) and higher inter-dialytic-weight-gain (IDWG)% (β = 0.13 [95%CI 0.06-0.19]; p = 0.0003). CONCLUSIONS: Children on HD had a significant and sustained increase in BP over 1 year compared to a stable BP in those on HDF, despite an equivalent dialysis dose. Higher IDWG% was associated with higher 24-h MAP-SDS in both groups.
BACKGROUND: Hypertension is prevalent in children on dialysis and associated with cardiovascular disease. We studied the blood pressure (BP) trends and the evolution of BP over 1 year in children on conventional hemodialysis (HD) vs. hemodiafiltration (HDF). METHODS: This is a post hoc analysis of the "3H - HDF-Hearts-Height" dataset, a multicenter, parallel-arm observational study. Seventy-eight children on HD and 55 on HDF who had three 24-h ambulatory BP monitoring (ABPM) measures over 1 year were included. Mean arterial pressure (MAP) was calculated and hypertension defined as 24-h MAP standard deviation score (SDS) ≥95th percentile. RESULTS: Poor agreement between pre-dialysis systolic BP-SDS and 24-h MAP was found (mean difference - 0.6; 95% limits of agreement -4.9-3.8). At baseline, 82% on HD and 44% on HDF were hypertensive, with uncontrolled hypertension in 88% vs. 25% respectively; p < 0.001. At 12 months, children on HDF had consistently lower MAP-SDS compared to those on HD (p < 0.001). Over 1-year follow-up, the HD group had mean MAP-SDS increase of +0.98 (95%CI 0.77-1.20; p < 0.0001), whereas the HDF group had a non-significant increase of +0.15 (95%CI -0.10-0.40; p = 0.23). Significant predictors of MAP-SDS were dialysis modality (β = +0.83 [95%CI +0.51 - +1.15] HD vs. HDF, p < 0.0001) and higher inter-dialytic-weight-gain (IDWG)% (β = 0.13 [95%CI 0.06-0.19]; p = 0.0003). CONCLUSIONS: Children on HD had a significant and sustained increase in BP over 1 year compared to a stable BP in those on HDF, despite an equivalent dialysis dose. Higher IDWG% was associated with higher 24-h MAP-SDS in both groups.
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