QJM. 2026 Aug 1;119(Supplement_1):hcag168.105. doi: 10.1093/qjmed/hcag168.105.
ABSTRACT
BACKGROUND: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in pediatric patients with chronic kidney disease (CKD). Online hemodiafiltration (OL-HDF) is a modality of hemodialysis (HD) improving CVD by enhancing hemodynamic stability, and endothelial function.
OBJECTIVE: To assess the baseline CV status in pediatric patients, stable maintenance HD and at 12 months from being shifted to OL- HDF modality.
METHODS: This was a prospective cohort study including a total of 38 patients; 21 males & 17 females with median (IQR) age of 11.32 (2.86) years. They were stable for at least 3 months on thrice weekly 3-hour HD sessions through an arteriovenous fistula using polysulphone membrane. HD vintage duration median (IQR) was 16.13 (28.4) months. Thirty- eight age, and sex matched healthy children served as a control group. Patients having congenital or acquired cardiac or vascular diseases, unsuitable vascular access blood flow, active inflammation or failed kidney graft were excluded. All selected patients were shifted to post-dilutional OL-HDF and followed up prospectively for 12 months. Cardiovascular status using conventional and speckle echocardiography, and common and internal carotid intima media thickness (cIMT) using ultrasound were assessed and measured at the baseline and at 12 months after being shifted to OL-HDF.
RESULTS: All recruited patients (100%) completed 12-month follow-up duration on post-dilution OL-HDF without any dropouts. OL-HDF resulted in significant decrease in left ventricular mass index Z score (p = 0.016) but remained higher than controls (p < 0.0001). OL-HDF had also improved the left ventricular (LV) systolic function parameters including ejection fraction % (EF%), fractional shortening % (FS%), global longitudinal strain % (GLS%) (p < 0.0001 for all). Notably, by the end of the study, the EF% and FS% were significantly higher than the controls (p < 0.0001 for both), but GLS% was comparable to controls (p = 0.067). Regarding left ventricular (LV) diastolic function, both deceleration time (DT) and the E/A ratio showed significant improvement (p < 0.0001 for both). However, DT remained significantly lower compared to controls (p = 0.001), while the E/A ratio became comparable to that of the control group (p = 0.074). Despite that OL-HDF resulted in a significant reduction in both common and internal cIMT (p < 0.0001) yet, they remained significantly higher than controls (p < 0.0001).
CONCLUSION: This study demonstrates that OL-HDF in children on maintenance HD due to CKD resulted in significant reduction of LVMI, significant improvement of LV systolic function, significant improvement of some LV diastolic function parameters and reduction of common and internal cIMT. These findings highlight OL-HDF as a promising HD modality for enhancing both cardiac and vascular health in this vulnerable population.
PMID:42689344 | DOI:10.1093/qjmed/hcag168.105
