Haemodiafiltration use in children: data from the Italian Pediatric Dialysis Registry

  • Fabio PaglialongaEmail author
  • Enrico Vidal
  • Carmine Pecoraro
  • Isabella Guzzo
  • Mario Giordano
  • Bruno Gianoglio
  • Ciro Corrado
  • Rosa Roperto
  • Ilse Ratsch
  • Salvatore Luzio
  • Luisa Murer
  • Silvia Consolo
  • Giovanni Pieri
  • Giovanni Montini
  • Alberto Edefonti
  • Enrico Verrina
Original Article
Part of the following topical collections:
  1. What's New in Dialysis



High volume haemodiafiltration (HDF) is associated with better survival than conventional haemodialysis (HD) in adults, but data concerning its use in children are lacking. The aim of this study was to assess the prevalence of paediatric HDF use and its associated factors in recent years in Italy.


We retrospectively reviewed the files of patients from the Italian Pediatric Dialysis Registry’s database who were registered between January 1, 2004 and December 31, 2016 and treated with extracorporeal dialysis for at least 6 months, looking in particular at modality and its associated factors.


One hundred forty-one out of 198 patients were treated exclusively with bicarbonate HD (71.2%), 57 with HDF (28.8%). Patients treated with HDF were younger (median 9.7 vs 13.2 years, p = 0.0008), were less often incident patients (52.6% vs 75.9%, p = 0.0031), had longer duration of the HD cycle (26.9 vs 20.8 months, p = 0.0036) and had a longer time to renal transplantation (32 vs 25 months, p = 0.0029) than those treated with bicarbonate HD only. The percentage of patients treated with HDF increased with dialysis vintage (16.9% at 6 months, 38.1% after more than 2 years of dialysis). The use of HDF was stable over time and was more common in the largest centres.


Over the observation period, HDF use in Italy has been limited to roughly a quarter of patients on extracorporeal dialysis, in particular to those with high dialysis vintage, younger age or a long expected waiting time to renal transplantation.


Extracorporeal dialysis Children Paediatric dialysis Haemodiafiltration Haemodialysis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kramer A, Stel VS, Tizard J, Verrina E, Ronnholm K, Palsson R, Maxwell H, Jager KJ (2009) Characteristics and survival of young adults who started renal replacement therapy during childhood. Nephrol Dial Transplant 24:926–933CrossRefGoogle Scholar
  2. 2.
    Chesnaye NC, Schaefer F, Groothoff JW, Bonthuis M, Reusz G, Heaf JG, Lewis M, Maurer E, Paripović D, Zagozdzon I, van Stralen KJ, Jager KJ (2016) Mortality risk in European children with end-stage renal disease on dialysis. Kidney Int 89:1355–1362CrossRefGoogle Scholar
  3. 3.
    US Renal Data System: USRDS 2015 Annual Data Report (2015) Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney DiseasesGoogle Scholar
  4. 4.
    Mitsnefes MM (2012) Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol 23:578–585CrossRefGoogle Scholar
  5. 5.
    Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629CrossRefGoogle Scholar
  6. 6.
    Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R, Hemodialysis (HEMO) Study Group (2002) Effect of dialysis dose and membrane flux in maintenance haemodialysis. N Engl J Med 347:2010–2019CrossRefGoogle Scholar
  7. 7.
    Perl J, Dember LM, Bargman JM, Browne T, Charytan DM, Flythe JE, Hickson LJ, Hung AM, Jadoul M, Lee TC, Meyer KB, Moradi H, Shafi T, Teitelbaum I, Wong LP, Chan CT, American Society of Nephrology Dialysis Advisory Group (2017) The use of a multidimensional measure of dialysis adequacy-moving beyond small solute kinetics. Clin J Am Soc Nephrol 12:839–847CrossRefGoogle Scholar
  8. 8.
    Blankestijn PJ, Ledebo I, Canaud B (2010) Haemodiafiltration: clinical evidence and remaining questions. Kidney Int 77:581–587CrossRefGoogle Scholar
  9. 9.
    Tattersall JE, Ward RA (2013) Online haemodiafiltration: definition, dose quantification and safety revisited. Nephrol Dial Transplant 28:542–550CrossRefGoogle Scholar
  10. 10.
    Ronco C (2015) Hemodiafiltration: technical and clinical issues. Blood Purif 40(Suppl 1):2–11CrossRefGoogle Scholar
  11. 11.
    Grooteman MP, van den Dorpel MA, Bots ML, Penne EL, van der Weerd NC, Mazairac AH, den Hoedt CH, van der Tweel I, Lévesque R, Nubé MJ, ter Wee PM, Blankestijn PJ, CONTRAST Investigators (2012) Effect of online haemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol 23:1087–1096CrossRefGoogle Scholar
  12. 12.
    Ok E, Asci G, Toz H, Ok ES, Kircelli F, Yilmaz M, Hur E, Demirci MS, Demirci C, Duman S, Basci A, Adam SM, Isik IO, Zengin M, Suleymanlar G, Yilmaz ME, Ozkahya M, Turkish Online Haemodiafiltration Study (2013) Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF study. Nephrol Dial Transplant 28:192–202CrossRefGoogle Scholar
  13. 13.
    Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, Carreras J, Soler J, Torres F, Campistol JM, Martinez-Castelao A, ESHOL Study Group (2013) High-efficiency postdilution online haemodiafiltration reduces all-cause mortality in haemodialysis patients. J Am Soc Nephrol 24:487–497CrossRefGoogle Scholar
  14. 14.
    Nistor I, Palmer SC, Craig JC, Saglimbene V, Vecchio M, Covic A, Strippoli GF (2014) Convective versus diffusive dialysis therapies for chronic kidney failure: an updated systematic review of randomized controlled trials. Am J Kidney Dis 63:954–967CrossRefGoogle Scholar
  15. 15.
    Susantitaphong P, Siribamrungwong M, Jaber BL (2013) Convective therapies versus low-flux haemodialysis for chronic kidney failure: a meta-analysis of randomized controlled trials. Nephrol Dial Transplant 28:2859–2874CrossRefGoogle Scholar
  16. 16.
    Wang AY, Ninomiya T, Al-Kahwa A, Perkovic V, Gallagher MP, Hawley C, Jardine MJ (2014) Effect of hemodiafiltration or hemofiltration compared with hemodialysis on mortality and cardiovascular disease in chronic kidney failure: a systematic review and meta-analysis of randomized trials. Am J Kidney Dis 63:968–978CrossRefGoogle Scholar
  17. 17.
    Mostovaya IM, Grooteman MP, Basile C, Davenport A, de Roij van Zuijdewijn CL, Wanner C, Nubé MJ, Blankestijn PJ (2015) High convection volume in online post-dilution haemodiafiltration: relevance, safety and costs. Clin Kidney J 8:368–373CrossRefGoogle Scholar
  18. 18.
    Peters SA, Bots ML, Canaud B, Davenport A, Grooteman MP, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ, HDF Pooling Project Investigators (2016) Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials. Nephrol Dial Transplant 31:978–984CrossRefGoogle Scholar
  19. 19.
    Basile C, Davenport A, Blankestijn PJ (2017) Why choose high volume online post-dilution hemodiafiltration? J Nephrol 30:181–186CrossRefGoogle Scholar
  20. 20.
    Fischbach M, Terzic J, Menouer S, Dheu C, Seuge L, Zalosczic A (2010) Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol Dial Transplant 25:867–873CrossRefGoogle Scholar
  21. 21.
    Fischbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A (2004) Daily on-line haemodiafiltration: a pilot trial in children. Nephrol Dial Transplant 19:2360–2367CrossRefGoogle Scholar
  22. 22.
    Fischbach M, Terzic J, Menouer S, Dheu C, Soskin S, Helmstetter A, Burger MC (2006) Intensified and daily haemodialysis in children might improve statural growth. Pediatr Nephrol 21:1746–1752CrossRefGoogle Scholar
  23. 23.
    Thumfart J, Puttkamer CV, Wagner S, Querfeld U, Muller D (2014) Hemodiafiltration in a pediatric nocturnal dialysis program. Pediatr Nephrol 29:1411–1416CrossRefGoogle Scholar
  24. 24.
    Schaefer F (2010) Daily online haemodiafiltration: the perfect ‘stimulus package’ to induce growth? Nephrol Dial Transplant 25:658–660CrossRefGoogle Scholar
  25. 25.
    Ağbaş A, Canpolat N, Çalışkan S, Yılmaz A, Ekmekçi H, Mayes M, Aitkenhead H, Schaefer F, Sever L, Shroff R (2018) Haemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux haemodialysis in children. PLoS One 13:e0198320CrossRefGoogle Scholar
  26. 26.
    Shroff R, Bayazit A, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Agbas A, Anarat A, Aoun B, Bakkaloglu S, Bhowruth D, Borzych-Dużałka D, Bulut IK, Büscher R, Dempster C, Duzova A, Habbig S, Hayes W, Hegde S, Krid S, Licht C, Litwin M, Mayes M, Mir S, Nemec R, Obrycki L, Paglialonga F, Picca S, Ranchin B, Samaille C, Shenoy M, Sinha M, Smith C, Spasojevic B, Vidal E, Vondrák K, Yilmaz A, Zaloszyc A, Fischbach M, Schaefer F, Schmitt CP (2018) Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children—the HDF, heart and height (3H) study. BMC Nephrol 19:199CrossRefGoogle Scholar
  27. 27.
    Shroff R, Bayazit A, Stefanidis C, Askiti V, Azukaitis K, Canpolat N, Bakkaloglu S (2017) Haemodiafiltration (HDF) is associated with superior fluid control and reduced cardiovascular risk profile compared to conventional haemodialysis (HD)—data from the HDF vs HD (3H) study. Pediatr Nephrol 32:1730Google Scholar
  28. 28.
    Fischbach M, Attal Y, Geisert J (1984) Haemodiafiltration versus haemodialysis in children. Int J Pediatr Nephrol 5:151–154PubMedGoogle Scholar
  29. 29.
    Cheung AK, Rocco MV, Yan G, Leypoldt JK, Levin NW, Greene T, Agodoa L, Bailey J, Beck GJ, Clark W, Levey AS, Ornt DB, Schulman G, Schwab S, Teehan B, Eknoyan G (2006) Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study. J Am Soc Nephrol 17:546–555CrossRefGoogle Scholar
  30. 30.
    Penne EL, van der Weerd NC, Blankestijn PJ, van den Dorpel MA, Grooteman MP, Nubé MJ, Ter Wee PM, Lévesque R, Bots ML, investigators CONTRAST (2010) Role of residual kidney function and convective volume on change in beta2-microglobulin levels in haemodiafiltration patients. Clin J Am Soc Nephrol 5:80–86CrossRefGoogle Scholar
  31. 31.
    Penne EL, van der Weerd NC, van den Dorpel MA, Grooteman MP, Lévesque R, Nubé MJ, Bots ML, Blankestijn PJ, ter Wee PM, CONTRAST Investigators (2010) Short-term effects of online haemodiafiltration on phosphate control: a result from the randomized controlled Convective Transport Study (CONTRAST). Am J Kidney Dis 55:77–87CrossRefGoogle Scholar
  32. 32.
    Donauer J, Schweiger C, Rumberger B, Krumme B, Bohler J (2003) Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis. Nephrol Dial Transplant 18:1616–1622CrossRefGoogle Scholar
  33. 33.
    Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini LA, Basile C, David S, Feriani M, Montagna G, Di Iorio BR, Memoli B, Cravero R, Battaglia G, Zoccali C (2010) Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD. J Am Soc Nephrol 21:1798–1807CrossRefGoogle Scholar
  34. 34.
    Shroff R, Fischbach M, Schaefer F, Edefonti A, Schmitt C, on behalf of the 4c Study Consortium (2014) Paediatric dialysis practice across the EU. Pediatr Nephrol 29:1667Google Scholar

Copyright information

© IPNA 2019

Authors and Affiliations

  • Fabio Paglialonga
    • 1
    Email author
  • Enrico Vidal
    • 2
  • Carmine Pecoraro
    • 3
  • Isabella Guzzo
    • 4
  • Mario Giordano
    • 5
  • Bruno Gianoglio
    • 6
  • Ciro Corrado
    • 7
  • Rosa Roperto
    • 8
  • Ilse Ratsch
    • 9
  • Salvatore Luzio
    • 10
  • Luisa Murer
    • 2
  • Silvia Consolo
    • 1
  • Giovanni Pieri
    • 1
  • Giovanni Montini
    • 1
  • Alberto Edefonti
    • 1
  • Enrico Verrina
    • 10
  1. 1.Pediatric Nephrology, Dialysis and Transplant UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women’s and Children’s HealthUniversity-HospitalPaduaItaly
  3. 3.Nephrology and Dialysis UnitSantobono Children’s HospitalNaplesItaly
  4. 4.Nephrology and Dialysis Unit, Department of Pediatrics“Bambino Gesù” Children’s Hospital-IRCCSRomeItaly
  5. 5.Nephrology Division and Dialysis UnitGiovanni XXIII Children’s HospitalBariItaly
  6. 6.Nephrology Dialysis and Transplantation UnitRegina Margherita University HospitalTurinItaly
  7. 7.Pediatric Nephrology and Dialysis UnitChildren’s Hospital G. Di CristinaPalermoItaly
  8. 8.Nephrology and Dialysis UnitMeyer Children’s HospitalFlorenceItaly
  9. 9.University Department of PediatricsUnited Hospitals of AnconaAnconaItaly
  10. 10.Dialysis Unit, Paediatric Nephrology and Dialysis DepartmentG Gaslini Children HospitalGenoaItaly

Personalised recommendations