Role of Online Hemodiafiltration in Improvement of Inflammatory Status in Pediatric Patients With End-stage Renal Disease

Patients with end-stage renal disease are known to suffer from chronic inflammation as the result of an ongoing subacute cytokine induction, which may contribute considerably to dialysis-related long-term morbidity and mortality. In order to assess the inflammatory risk associated with online hemodiafiltration compared to conventional hemodialysis, we compared the cytokine induction profile of pediatric patients during treatment with each these modalities of dialysis. Thirty pediatric patients on regular hemodialysis for at least 6 months were shifted to online hemodiafiltration. We collected serum samples before and 6 months after initiation of online hemodiafilration. The target pro-inflammatory cytokines selected were interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein. High-sensitivity C-reactive protein decreased significantly on hemodiafiltration. The mean C-reactive protein level after 6 months was 3.41 μg/mL in the online hemodiafilration as compared to 7.98 μg/mL in the hemodialysis group (P =. 01). Plasma interleukin-6 and tumor necrosis factor-α and tumor necrosis factor-α also decreased significantly on hemodiafiltration and the values were 100.44 pg/mL versus 168.40 pg/mL (P =. 002) and 11.45 pg/mL versus 15.70 pg/mL (P =. 008), respectively, for the hemodiafilration and hemodialysis groups. Online hemodiafiltration is associated with dampened pro-inflammatory cytokine profile compared to conventional hemodialysis in children with end-stage renal disease.