Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 12.
doi: 10.1007/s00467-025-06924-w. Online ahead of print.

Comparing outcomes with different dialysis modalities in children with kidney failure: home hemodialysis versus in-center hemodiafiltration or conventional hemodialysis

Charlotte Ahlmann  1   2 , Iona Madden  3 , Andreas Busjahn  4 , Olga Panagiotopoulou  1 , Karolis Azukaitis  5 , Sevcan A Bakkaloglu  6 , Ayşe Ağbaş  7 , Ali Anarat  8 , Varvara Askiti  9 , Aysun K Bayazit  8 , Ipek Kaplan Bulut  10 , Nur Canpolat  7 , Dagmara Borzych-Duzalka  11 , Ali Duzova  12 , Sandra Habbig  13 , Saoussen Krid  14 , Christoph Licht  15 , Mieczyslaw Litwin  16 , Lukasz Obrycki  16 , Fabio Paglialonga  17 , Bruno Ranchin  18 , Charlotte Samaille  19 , Mohan Shenoy  20 , Manish D Sinha  21 , Brankica Spasojevic  22 , Lynsey Stronach  1 , Enrico Vidal  23 , Alev Yilmaz  24 , Michel Fischbach  25 , Franz Schaefer  26 , Claus Peter Schmitt  26 , Jun Oh  2 , Daljit Hothi  1 , Rukshana Shroff  1
Affiliations

Comparing outcomes with different dialysis modalities in children with kidney failure: home hemodialysis versus in-center hemodiafiltration or conventional hemodialysis

Charlotte Ahlmann et al. Pediatr Nephrol. .

Abstract

Background: Home hemodialysis (HHD) and hemodiafiltration (HDF) have independently shown superior cardiovascular outcomes compared with conventional hemodialysis (HD) in adults, but pediatric data are scarce. We compared outcomes on HHD, HDF and HD therapies in children.

Methods: Single-center data from HHD patients over 13 years were compared with the multicenter prospective "3H - HDF, Heart and Height" study. Systolic blood pressure [SBP] standard deviation score [SDS], left ventricular mass index [LVMI], height-SDS, biochemical markers, dialysis-related symptoms and medication burden were compared within the HHD cohort and between the three dialysis modalities at baseline and 12 months.

Results: Among 38 HHD patients with complete follow-up, there were no improvements in SBP-SDS, LVMI or height-SDS over 12 months. Serum phosphate levels decreased (median difference -0.15 mmol/L [95% CI -0.5 to -0.1]; p = 0.002) and hemoglobin increased (+ 1.1 g/dL [95% CI 0.3 to 2.0]; p = 0.01). Comparing 38 HHD patients to 55 HDF and 78 HD patients, SBP-SDS, LVMI, and height-SDS were comparable between HHD and HDF at 12 months. LVMI was lower in HHD compared with HD (-11.8 g/m2.16 [95% CI -16.0 to -4.1]; p = 0.003). SBP-SDS and height-SDS were comparable between HHD and HD. PTH and hemoglobin were comparable between HHD and HDF, despite lower phosphate levels in HHD. The frequency of dialysis-related symptoms were comparable between HHD and HDF, and less frequent than in HD.

Conclusions: In pediatric patients, HHD and HDF showed comparable outcomes for cardiovascular burden, growth, and dialysis-related symptoms, and both demonstrated superior clinical outcomes compared with conventional HD.

Keywords: Cardiovascular disease; Children; Conventional hemodialysis (HD); Growth; Hemodiafiltration (HDF); Home hemodialysis (HHD).

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: RS has received research grants from Fresenius Medical Care, is on the Scientific Advisory Board of Fresenius Medical Care, and has received speaker honoraria from Fresenius Medical Care, Amgen, Vitaflo, Triomed and Humacyte. CPS has received consulting fees from Chiesi, Baxter, StadaPharma and Bioporto; lecture honorarium and travel support from Chiesi; and research funding from Invizius and Baxter. JO has received research funding from Fresenius Medical Care and received honoraria for his role in advisory board meetings from Astra Zeneca. CA, IM, AB, OP, KA, SB, AA, AA, VA, AB, IB, NC, DBD, AD, SH, SK, CL, ML, LO, FP, BR, CS, MS, MDS, BS, LS, EV, AY, MF, FS and DH have no relevant financial or non-financial interests to disclose. The 3H study was sponsored by Kidney Research UK. Part sponsorship was obtained from Fresenius Medical Care, who approved the study protocol, but had no role in data collection, data analysis or drafting the present manuscript.

References

    1. United States Renal Data System (2023) 2023 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. https://usrds-adr.niddk.nih.gov/2023 . Accessed 3 May 2025
    1. Fine RN, Ho M, Tejani A (2001) The contribution of renal transplantation to final adult height: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Nephrol 16:951–956. https://doi.org/10.1007/s004670100002 - DOI - PubMed
    1. Guha C, van Zwieten A, Khalid R, Kim S, Walker A, Francis A, Didsbury M, Teixeira-Pinto A, Barton B, Prestidge C, Lancsar E, Mackie F, Kwon J, Howard K, Mallitt KA, Howell M, Jaure A, Hayes A, Raghunandan R, Petrou S, Lah S, McTaggart S, Craig JC, Wong G (2023) Longitudinal assessment of the health-related quality of life of children and adolescents with chronic kidney disease. Kidney Int 103:357–364. https://doi.org/10.1016/j.kint.2022.09.026 - DOI - PubMed
    1. ERA Registry (2024) ERA Registry Annual Report 2022. Amsterdam UMC, Department of Medical Informatics, Amsterdam, the Netherlands. https://www.era-online.org/wp-content/uploads/2024/09/ERA-Registry-Annua... . Accessed 3 May 2025
    1. Weaver DJ Jr, Somers MJG, Martz K, Mitsnefes MM (2017) Clinical outcomes and survival in pediatric patients initiating chronic dialysis: a report of the NAPRTCS registry. Pediatr Nephrol 32:2319–2330. https://doi.org/10.1007/s00467-017-3759-4 - DOI - PubMed

LinkOut - more resources