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Hemodiafiltration Is Associated With Reduced Inflammation and Increased Bone Formation Compared With Conventional

Dagmar-Christiane Fischer1, Colette Smith2, Francesca De Zan3

  • 1Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany.

Kidney International Reports
|September 13, 2021
PubMed

Insights

Children on hemodiafiltration (HDF) show reduced inflammation and improved bone formation markers compared to conventional hemodialysis (HD). This suggests HDF may offer benefits for bone health in pediatric patients undergoing dialysis.

Area of Science:

  • Pediatric Nephrology
  • Bone Metabolism
  • Renal Replacement Therapy

Background:

  • Patients on dialysis face significant bone disease burden, including fractures.
  • Chronic kidney disease (CKD) impacts bone health through various mechanisms.
  • Understanding bone comorbidities in pediatric dialysis patients is crucial.

Purpose of the Study:

  • To determine the prevalence and risk factors for CKD-related bone disease in children on hemodiafiltration (HDF) versus conventional hemodialysis (HD).
  • To compare bone turnover markers, inflammatory markers, FGF-23, and klotho levels between HDF and HD cohorts.

Main Methods:

  • Post hoc analysis of the prospective cohort study HDF, Hearts and Heights (3H).
  • Included 103 children (61 HD, 42 HDF) with 12-month follow-up.
  • Measured biomarkers of bone formation/resorption, inflammation, FGF-23, and klotho.

Main Results:

  • HDF cohort showed lower inflammatory markers (IL-6, TNF-α, hs-CRP) at baseline and 12 months.
  • The bone-specific alkaline phosphatase/tartrate-resistant acid phosphatase 5b ratio increased in HDF but not HD after 12 months.
  • The FGF-23/klotho ratio was significantly higher in the HD group compared to HDF after 12 months.

Conclusions:

  • Children on HDF exhibit an attenuated inflammatory profile and increased bone formation compared to HD.
  • HDF is associated with lower FGF-23/klotho ratios, potentially indicating better bone health.
  • Further long-term studies are needed to link these biomarker improvements to fracture risk and cardiovascular outcomes.
Abstract

Keywords:
hemodiafiltrationhemodialysisinflammationmineral bone diseasepediatric nephrology

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