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.
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Acknowledgments
RS is funded by a National Institute for Health Research (NIHR), Career Development Fellowship for this research project. This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. A part of the work took place in the Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.
Funding
The 3H study was sponsored by Kidney Research UK. Part sponsorship was obtained from Fresenius Medical Care, who approved the study protocol, but had no role in data collection, data analysis or drafting the manuscript.
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RS is the Principal Investigator and obtained funding. RS, EV, CPS and FS designed the study. RS, FDZ and CS drafted the paper. CS performed the statistical analyses. All authors read and approved the final manuscript.
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RS has an investigator-initiated study funded by Fresenius Medical Care and has received speaker honoraria from Fresenius Medical Care and Amgen. CPS and FS received funding for investigator-initiated research from Fresenius Medical Care, and CPD also from Amgen.
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The study was performed according to the principles of the declaration of Helsinki. It has been approved by the NRES (National Research Ethics Service) Committee London—Bloomsbury, a Research Ethics Committee established by the Health Research Authority, England. Approval from local Institutional Review Boards was obtained for each participating site.
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ESM 1
Supplemental Fig. 1. Pre-dialysis systolic blood pressure SDS by treatment modality and age groups at baseline (1A) and 12 months (1B). Supplemental Fig. 2. Pre-dialysis diastolic blood pressure SDS by treatment modality and age groups at baseline (2A) and 12 months (2B). Supplemental Fig. 3. Distribution of hypertension in HD and HDF patients based on systolic and diastolic blood pressure at baseline (3A) and 12 months (3B). The Y-axis indicates the percentage of patients in each category. Striped columns represent BP < 95th percentile and filled columns represent BP > 95th percentile. (PDF 265 kb)
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De Zan, F., Smith, C., Duzova, A. et al. Hemodiafiltration maintains a sustained improvement in blood pressure compared to conventional hemodialysis in children—the HDF, heart and height (3H) study. Pediatr Nephrol 36, 2393–2403 (2021). https://doi.org/10.1007/s00467-021-04930-2
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DOI: https://doi.org/10.1007/s00467-021-04930-2