Impact of online hemodiafiltration on bone turnover in children with CKD-5d: A prospective cohort study.

IF 2.6 3区医学 Q1 PEDIATRICS

Pediatric Nephrology Pub Date : 2025-10-01 Epub Date: 2025-05-19 DOI:10.1007/s00467-025-06805-2

Mohammed F Kasem, Ragia M Said, Aliaa Mourad, Noha R Mohamed, Noha U Hashem

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引用次数: 0

Abstract

Background: Mineral bone disorder (MBD) is a systemic disorder associated with chronic kidney disease (CKD). Online hemodiafiltration (OL-HDF) combines hemodialysis (HD) and hemofiltration and has shown promising results in children with CKD-5d considering co-morbidities.

Methods: Children with CKD-5d who were stable for at least 3 months on thrice weekly 3-h HD sessions via an arteriovenous fistula (AVF) using polysulphone membrane were shifted to post-dilution OL-HDF and followed up for 12 months. Baseline Ca, PO4, serum albumin, alkaline phosphatase, iPTH, CRP, soluble Klotho, FGF-23, BALP and TRAP-5b were assessed and repeated at the end of the 12-month follow-up period.

Results: We included 31 children (17 males) with median age of 12.5 (IQR = 9.7-13.3) years and median HD vintage of 60.1 (IQR = 9.1-37.5) months. OL-HDF resulted in a statistically significant decrease in FGF-23 and FGF-23/Klotho ratios and insignificant increase in the levels of Klotho compared to their baseline values. It also led to statistically significant increase in BALP, decrease in TRAP-5b and elevation of the BALP/TRAP-5b ratio compared to their baseline values. A 12-month period of OL-HDF treatment had no significant effect on height Z-score before and after exclusion of patients having deformities of lower limbs.

Conclusion: OL-HDF resulted in a significant decrease in FGF-23, TRAP-5b and FGF-23/Klotho ratio with a significant increase in BALP and BALP/TRAP ratio. This might signify a promising positive impact on bone turnover in children with CKD-5d.

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在线血液滤过对CKD-5d患儿骨转换的影响：一项前瞻性队列研究

背景：矿物质骨疾病（MBD）是一种与慢性肾脏疾病（CKD）相关的全身性疾病。在线血液滤过（OL-HDF）结合血液透析（HD）和血液滤过，在考虑合并症的CKD-5d儿童中显示出令人鼓舞的结果。方法：使用聚砜膜通过动静脉瘘（AVF）进行每周3次3小时HD治疗，稳定至少3个月的CKD-5d患儿转移至稀释后OL-HDF，随访12个月。在12个月的随访结束时，评估基线Ca、PO4、血清白蛋白、碱性磷酸酶、iPTH、CRP、可溶性Klotho、FGF-23、BALP和TRAP-5b。结果：我们纳入31名儿童（17名男性），中位年龄12.5 （IQR = 9.7-13.3）岁，中位HD年龄60.1 （IQR = 9.1-37.5）个月。与基线值相比，OL-HDF导致FGF-23和FGF-23/Klotho比率有统计学意义的降低，Klotho水平无统计学意义的增加。与基线值相比，它还导致BALP升高，TRAP-5b降低，BALP/TRAP-5b比值升高，具有统计学意义。OL-HDF治疗12个月对排除下肢畸形患者前后的身高z评分无显著影响。结论：OL-HDF导致FGF-23、TRAP-5b和FGF-23/Klotho比值显著降低，BALP和BALP/TRAP比值显著升高。这可能意味着对CKD-5d儿童的骨转换有积极的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Nephrology 医学-泌尿学与肾脏学

CiteScore

4.70

自引率

20.00%

发文量

465

审稿时长

1 months

期刊介绍： International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.