Mohammed F Kasem, Ragia M Said, Aliaa Mourad, Noha R Mohamed, Noha U Hashem
{"title":"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","authors":"Mohammed F Kasem, Ragia M Said, Aliaa Mourad, Noha R Mohamed, Noha U Hashem","doi":"10.1007/s00467-025-06805-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"3253-3262"},"PeriodicalIF":2.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401763/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of online hemodiafiltration on bone turnover in children with CKD-5d: A prospective cohort study.\",\"authors\":\"Mohammed F Kasem, Ragia M Said, Aliaa Mourad, Noha R Mohamed, Noha U Hashem\",\"doi\":\"10.1007/s00467-025-06805-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":19735,\"journal\":{\"name\":\"Pediatric Nephrology\",\"volume\":\" \",\"pages\":\"3253-3262\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401763/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00467-025-06805-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/19 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00467-025-06805-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/19 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Impact of online hemodiafiltration on bone turnover in children with CKD-5d: A prospective cohort study.
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.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
