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Background <p>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> Methods <p>Children with&#xa0;CKD-5d who were stable for at least 3&#xa0;months on thrice weekly 3-h HD sessions via an&#xa0;arteriovenous fistula (AVF) using polysulphone membrane were shifted to post-dilution OL-HDF and followed up for 12&#xa0;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> Results <p>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> Conclusion <p>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> Graphical abstract <p></p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月19日

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

摘要

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.

Graphical abstract