FP766ONLINE HEMODIAFILTERATION USE IN CHILDREN: A SINGLE CENTER EXPERIENCE WITH A TWIST

Abstract

Introduction and Aims:Hemodialysis (HD), when invented, wasabreak-through treatment for patients with end stage renal disease, saving them from otherwise dying out of fluid and toxin overload. Many efforts were put into improving the modality to give them a better quality of life and hemodiafilteration is a good example of the effort. Hemofiltration (HF) is removal of huge amount of fluid more than necessary to restore euvolemia, under effect of pressure gradient, with replacement of this fluid by intravenous infusion of exogenous high purity fluid. This ultrapure fluid is prepared by dialysis machine during dialysis session in a process called online Hemodiafiltration (OL-HDF). However, this OL-HDF is not yet used worldwide especially in children. In addition, only a very small number of reports have been published on the effectiveness and safety of online HDF in children till now. As such, the clinical experience of OL-HDF is still limited, especially in the developing countries, including Egypt where the high cost of this new modality represents an important obstacle The purpose of this study was to evaluate the benefits of incorporating HDF in different doses in the regimen of children with ESRD in addition to their conventional HD sessions. Methods: In this sequential clinical follow up study, 34 pediatric patients with ESRD on regular hemodialysis in the Pediatric Dialysis Unit, Children's Hospital, Ain Shams University were followed up on 2 phases: initial phase (all patients on HD thrice weekly for 3 months) and second phase, all patients were randomized into 2 groups, HDF group and HD group, the former was subdivided into once weekly HDF subgroup and twice weekly HDF subgroup. They were evaluated using drug history, history of dialysis related complications, clinical and laboratory parameters at 0, 3, 9 and 18 months. Results: On short term, the current study found that the HDF group, compared to HD group showed statistically significant difference in percentage change of weight SDS, height SDS, post dialysis fatigue frequency, Hb, P, PTH, IL-6, CRP, Kt/V, Epo dose/kg, Epo/Hct ratio in favor of the former. Also, on short term, we found that once subgroup, compared to twice subgroup, showed statistically significant difference in percentage change of post dialysis fatigue frequency, Hb, PTH, IL-6, Kt/V, hs-CRP in favor of the latter. On long term, the HDF group, compared to HD group, showed statistically significant difference in percentage change of weight SDS, height SDS, post dialysis fatigue frequency, Hb, PTH, b2m, IL-6, hs-CRP, Kt/V, Epo dose/kg, Epo/Hct ratio in favor of the former. Also, once subgroup, compared to twice subgroup showed statistically significant difference in percentage change of IL-6, hs-CRP, KT/V in favor of the latter. Conclusions: the substitution of once ortwice weeklyHD sessions with OL-HDF sessions was beneficial in most of the clinical and laboratory parameters measured; Clinical as growth and dialysis related complication and laboratory as anemia, Ca-P metabolism, middle molecules clearance and inflammatory profile. On long term, the twice weekly HDF sessions were statistically better than once in correction of inflammatory profile and elevation of Kt/V. Otherwise, no statistically significant difference was found between once and twice weekly HDF. This can raise hope for partial use of OL-HDF in developing countries improving outcomes of HD without significantly affecting the cost.