title: [Online hemodiafiltration in children and hypoparathyroidism: a single-centre series of cases].
abstract: BACKGROUND
  Due to technical requirements and cost, hemodiafiltration (HDF) is not widely used in pediatrics. We have been using online HDF (oHDF) since 2009 and we observed low parathyroid hormone (PTH) levels despite the accurate management of CKD-MBD.
  
  
  METHODS
  We reviewed the medical charts and parameters of mineral metabolism assessed on a before/after session basis in the 6 children undergoing chronic oHDF in our centre.
  
  
  RESULTS
  We observed low (<80pg/mL) PTH levels in all 6 patients and very low (<45pg/mL) PTH levels in 5, two of them presenting with pathological fractures. These low PTH levels were reversed after decreasing calcium concentration to 1.25 mmol/L in the dialysate, suggesting that high-efficiency oHDF may expose children to calcium during sessions in a too important amount when using 1.5 mmol/L dialysates. Last, C-terminal FGF23 levels before sessions were relatively low (<1600RU/mL), with a 32% clearance by oHDF.
  
  
  CONCLUSIONS
  PTH levels should be closely monitored in pediatric oHDF and solutions with a calcium concentration of 1.25 mmol/L should be used as first line in these patients.
authors.affiliation: Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, groupement hospitalier Est, 69500 Bron, France. Electronic address: thomasdemontclos@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pérouse de Montclos
authors.affiliation: Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, groupement hospitalier Est, 69500 Bron, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Ranchin
authors.affiliation: Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, groupement hospitalier Est, 69500 Bron, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Leclerc
authors.affiliation: Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, groupement hospitalier Est, 69500 Bron, France.
authors.forename: Aurélia
authors.initials: A
authors.lastname: Bertholet-Thomas
authors.affiliation: Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, groupement hospitalier Est, 69500 Bron, France; Université de Lyon, 69008 Lyon, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Belot
authors.affiliation: Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, groupement hospitalier Est, 69500 Bron, France; Université de Lyon, 69008 Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cochat
authors.affiliation: Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, groupement hospitalier Est, 69500 Bron, France; Université de Lyon, 69008 Lyon, France.
authors.forename: Justine
authors.initials: J
authors.lastname: Bacchetta
mesh_terms: D000293:Adolescent; D002118:Calcium / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D002648:Child; D002675:Child, Preschool; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000209:etiology*; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D005598:Fractures, Spontaneous / Q000209:etiology; D017583:Hemodiafiltration / Q000009:adverse effects* / Q000379:methods; D015312:Hemodialysis Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D012189:Retrospective Studies
chemical_list: C000717427:FGF23 protein, human; D015312:Hemodialysis Solutions; D010281:Parathyroid Hormone; D010758:Phosphorus; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002118:Calcium
keywords: Calcium; FGF23; Hormone parathyroïdienne; Hémodiafiltration online; Online hemodiafiltration; Parathyroid hormone; Pediatrics; Pédiatrie