Hemodiafiltration Is Associated With Reduced Inflammation and Increased Bone Formation Compared With Conventional Hemodialysis in Children: The HDF, Hearts and Heights (3H) Study
Makaleler > Tam Makale · 2021
Yazarlar: Dagmar-Christiane Fischer, Colette Smith, Francesca De Zan, Justine Bacchetta, SEVCAN AZİME BAKKALOĞLU EZGÜ, Ayşe AĞBAŞ, Ali Anarat, Bilal Aoun, Varvara Askiti, Karolis Azukaitis, AYSUN KARABAY BAYAZIT, İpek KAPLAN BULUT, Nur CANPOLAT, Dagmara Borzych-Duzalka, Ali Duzova, Sandra Habbig, Saoussen Krid, Christoph Licht, Mieczyslaw Litwin, Lukasz Obrycki, Fabio Paglialonga, Anja Rahn, Bruno Ranchin, Charlotte Samaille, Mohan Shenoy, Manish D. Sinha, Brankica Spasojevic, Constantinos J. Stefanidis, Enrico Vidal, Alev Yilmaz, Michel Fischbach, Franz Schaefer, Claus Peter Schmitt, Rukshana Shroff
Kidney International Reports, SCI Expanded İndekslerine Giren Dergi, Uluslararası, Wos, 2021, cilt 6, ss 2358-2370
DOI: 10.1016/j.ekir.2021.06.025
Özet
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-α, 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.