BACKGROUND: Hypertension and cardiovascular disease are common in children undergoing dialysis. Studies suggest that hemodiafiltration (HDF) may reduce cardiovascular mortality in adults, but data for children are scarce. METHODS: The HDF, Heart and Height study is a nonrandomized observational study comparing outcomes on conventional hemodialysis (HD) versus postdilution online HDF in children. Primary outcome measures were annualized changes in carotid intima-media thickness (cIMT) SD score and height SD score. RESULTS: We enrolled 190 children from 28 centers; 78 on HD and 55 on HDF completed 1-year follow-up. The groups were comparable for age, dialysis vintage, access type, dialysis frequency, blood flow, and residual renal function. At 1 year, cIMT SD score increased significantly in children on HD but remained static in the HDF cohort. On propensity score analysis, HD was associated with a +0.47 higher annualized cIMT SD score compared with HDF. Height SD score increased in HDF but remained static in HD. Mean arterial pressure SD score increased with HD only. Factors associated with higher cIMT and mean arterial pressure SD-scores were HD group, higher ultrafiltration rate, and higher β2-microglobulin. The HDF cohort had lower β2-microglobulin, parathyroid hormone, and high-sensitivity C-reactive protein at 1 year; fewer headaches, dizziness, or cramps; and shorter postdialysis recovery time. CONCLUSIONS: HDF is associated with a lack of progression in vascular measures versus progression with HD, as well as an increase in height not seen in the HD cohort. Patient-related outcomes improved among children on HDF correlating with improved BP control and clearances. Confirmation through randomized trials is required.

Nephrology Unit Armand Trousseau Hospital Paris France

Nephrology Unit Bambino Gesù Children Research Hospital Rome Italy

Nephrology Unit Center for Pediatrics and Adolescent Medicine Heidelberg Germany

Nephrology Unit Cerrahpasa School of Medicine Istanbul Turkey

Nephrology Unit Children's Dialysis Center Strasbourg France; and

Nephrology Unit Children's Memorial Health Institute Warsaw Poland

Nephrology Unit Clinic of Pediatrics Vilnius University Vilnius Lithuania

Nephrology Unit Cukurova University Adana Turkey

Nephrology Unit Ege University Faculty of Medicine Izmir Turkey

Nephrology Unit Fondazione Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Nephrology Unit Gazi University Hospital Ankara Turkey

Nephrology Unit Great Ormond Street Hospital for Children NHS Foundation Trust Great Ormond Street London United Kingdom and

Nephrology Unit Hacettepe University Ankara Turkey

Nephrology Unit Hôpital Jeanne De Flandre Lille Cedex France

Nephrology Unit Hôpital Necker Enfants Malades Paris France

Nephrology Unit Istanbul University Faculty of Medicine Istanbul Turkey

Nephrology Unit Kings College London Evelina London Children's Hospital London United Kingdom

Nephrology Unit Kyriakou Children's Hospital Athens Greece

Nephrology Unit Medical University of Gdansk Gdansk Poland

Nephrology Unit Pediatric Dialysis and Transplant Unit Padova Italy

Nephrology Unit Royal Manchester Children's Hospital Manchester United Kingdom

Nephrology Unit The Hospital for Sick Children Toronto Canada

Nephrology Unit University Children Hospital Essen Essen Germany

Nephrology Unit University Children's Hospital Belgrade Serbia

Nephrology Unit University Hospital Cologne Cologne Germany

Nephrology Unit University Hospital Motol Prague Czech Republic

Nephrology Unit University Hospital of Wales Cardiff United Kingdom

Renal Unit Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France

Statistics Department Institute for Global Health University College London London United Kingdom

Vascular Physiology Unit University College London Institute of Child Health Gower Street London United Kingdom

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