Bland Altman plot comparing the composite measure of intima thickness and medial thickness (IT + MT) by ultra-high-frequency ultrasound with conventional cIMT.

<p>Bland Altman plot comparing the composite measure of intima thickness and medial thickness (IT + MT) by ultra-high-frequency ultrasound with conventional cIMT.</p

Changes in ultra-high-frequency ultrasound measures at one year follow-up.

<p><b>(Fig 4A</b>—Comparison of baseline and 1-year follow-up measures of common carotid artery (CCA) medial thickness (MT) in transplanted children, <b>Fig 4B</b>—Comparison of baseline and 1-year follow-up measures of dorsal pedal artery intimal thickness (IT) in transplanted children).</p

Correlation of ultra-high-frequency ultrasound measures with biochemical markers.

<p><b>(Fig 3A–</b>Association of serum phosphate with common carotid artery (CCA) medial thickness (MT), <b>Fig 3B–</b>Association of serum parathyroid hormone level (log transformed) with CCA MT, <b>Fig 3C–</b>Association of mean arterial pressure standard deviation score (SDS) with CCA MT, <b>Fig 3D–</b>Association of diastolic BP SDS with dorsal pedal artery MT).</p

Ultra-high-frequency ultrasound images of carotid and dorsal pedal arteries, and comparison with images obtained by conventional ultrasound.

<p><b>Fig 1A</b>—Carotid artery scanned with 12 MHz (left) and 55 MHz (right) ultrasound. Outtake shows magnification of intima-media complex from 55 MHz image with outline of intima and media thickness. <b>Fig 1B</b>—Dorsal pedal artery of control child (left) and child on hemodialysis (right) scanned with 70 MHz probe).</p

Ultra-high-frequency ultrasound measurements of intima thickness (IT), medial thickness (MT) and the composite measure of IMT in carotid (Fig 2A) and dorsal pedal (Fig 2B) arteries in healthy controls and children with CKD4-5 and on dialysis (CKD4-5D) and transplanted patients.

<p>CCA–common carotid artery.</p

Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children

<div><p>Randomized trials in adults have shown reduced all-cause and cardiovascular mortality on hemodiafiltration (HDF) compared to high-flux hemodialysis (HD), but the mechanisms leading to improved outcomes are not clear. We studied biomarkers of inflammation, oxidative stress, anti-oxidant capacity and endothelial dysfunction in 22 children (13 female, age 8–15 years). All children received HD for at least 3 months, and were then switched to HDF, keeping all dialysis related parameters and dialysis time constant. All the biomarkers of inflammation (ß2-microglobulin, IL-6, IL-10, high sensitive C-reactive protein [hsCRP]), oxidative stress (nitrotyrosine, advanced glycation end-products [AGEs], oxidized low density lipoprotein [ox-LDL] and anti-oxidant capacity) and endothelial dysfunction (asymmetric dimethyl arginine [ADMA], symmetric dimethyl arginine [SDMA]), were comparable between incident and prevalent patients on HD, suggesting that even a short dialysis vintage of 3 months on HD increases inflammation and endothelial stress. After 3 months of HDF therapy there was a significant reduction in ß2-microglobulin (p<0.001), hCRP, ADMA, SDMA, AGEs, ox-LDL (p<0.01 for all) and an increase in total antioxidant capacity (p<0.001) compared to HD. All children were maintained on the same dialyser, dialysis water quality, dialysis time and blood flow speeds suggesting that improved clearances on HDF led to an improved biomarker profile. Even in children with residual renal function there was a significant reduction in ß2 microglobulin, hsCRP, SDMA, ox-LDL and AGEs on HDF compared to HD. Children with a lower blood flow had higher inflammatory status (higher IL-6/IL-10 ratio; p = 0.04, r = -0.43). Children who achieved a higher convective volume (≥median 12.8L/m²) had lower ox-LDL (p = 0.02). In conclusion, we have shown that a significant improvement in inflammation, antioxidant capacity and endothelial risk profile is achieved even within a short time (3 months) on HDF compared to HD treatment.</p><p><b><i>Trial Registration</i>:</b> ClinicalTrials.gov: <a href="https://clinicaltrials.gov/ct2/show/NCT02063776" target="_blank">NCT02063776</a>.</p></div

Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children - Fig 3

<p>Percent increase in TAC and percent decrease in SDMA from HD to HDF was more pronounced in patients with higher blood flow rate (A,B). Higher blood flow rate was also associated with lower IL-6 to IL-10 ratio on HDF (C). Percent change = [(HDF-HD)/HD]*100.</p

Comparison of biomarkers in children with and without residual renal function (RRF) on high-flux HD and HDF.

<p>Markers of oxidative stress (A), inflammation (B) and endothelial dysfunction (C) were significantly decreased in addition to a significant increase in anti-oxidant capacity on HDF compared to HD. This improvement was observed not only in patients without RRF but also in patients with RRF.</p

Baseline characteristics of the patients.

<p>Baseline characteristics of the patients.</p

Demonstrating the molecular weights of the studied markers and comparison with albumin.

<p>AGEs are not shown in the figure because they are composed of several molecules, which are mostly middle molecules.</p