{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:27:56Z","timestamp":1778736476474,"version":"3.51.4"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002352","name":"Ain Shams University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Nephrol"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats: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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Children with\u00a0CKD-5d who were stable for at least 3\u00a0months on thrice weekly 3-h HD sessions via an\u00a0arteriovenous fistula (AVF) using polysulphone membrane were shifted to post-dilution OL-HDF and followed up for 12\u00a0months. 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>We included 31 children (17 males) with median age of 12.5 (IQR\u2009=\u20099.7\u201313.3) years and median HD vintage of 60.1 (IQR\u2009=\u20099.1\u201337.5) 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats: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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00467-025-06805-2","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T10:30:20Z","timestamp":1747650620000},"page":"3253-3262","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of online hemodiafiltration on bone turnover in children with CKD-5d: A prospective cohort study"],"prefix":"10.1007","volume":"40","author":[{"given":"Mohammed F.","family":"Kasem","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0067-5222","authenticated-orcid":false,"given":"Ragia M.","family":"Said","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliaa","family":"Mourad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noha R.","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noha U.","family":"Hashem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"6805_CR1","doi-asserted-by":"publisher","first-page":"2376","DOI":"10.1016\/j.ekir.2022.08.007","volume":"7","author":"J Piotte","year":"2022","unstructured":"Piotte J, Louis F, Buyansky D, Mereniuk E, L\u00e9vesque R, Wald R, Cailhier J-F, C\u00f4t\u00e9 J-M, Beaubien-Souligny W (2022) Online hemodiafiltration compared to conventional hemodialysis in critically ill patients. Kidney Int Rep 7:2376\u20132387","journal-title":"Kidney Int Reports"},{"key":"6805_CR2","doi-asserted-by":"publisher","first-page":"2611","DOI":"10.1007\/s00467-024-06285-w","volume":"39","author":"C Ahlmann","year":"2024","unstructured":"Ahlmann C, Stronach L, Waters K, Walker K, Oh J, Schmitt CP, Ranchin B, Shroff R (2024) Hemodiafiltration for children with stage 5 chronic kidney disease: technical aspects and outcomes. Pediatr Nephrol 39:2611\u20132626","journal-title":"Pediatr Nephrol"},{"key":"6805_CR3","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.3390\/jcm13041110","volume":"13","author":"F Maduell","year":"2024","unstructured":"Maduell F, Rodr\u00edguez-Espinosa D, Broseta JJ (2024) Latest Trends in Hemodiafiltration. J Clin Med 13:1110","journal-title":"J Clin Med"},{"key":"6805_CR4","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.semnephrol.2012.12.017","volume":"33","author":"K Wesseling-Perry","year":"2013","unstructured":"Wesseling-Perry K, Salusky IB (2013) Chronic kidney disease: mineral and bone disorder in children. Semin Nephrol 33:169\u2013179","journal-title":"Semin Nephrol"},{"key":"6805_CR5","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3339\/jkspn.2020.24.1.14","volume":"24","author":"J-S Suh","year":"2020","unstructured":"Suh J-S (2020) Diagnosis and Management of Chronic Kidney Disease-Mineral Bone Disease in Children. Child Kidney Dis 24:14\u201318","journal-title":"Child Kidney Dis"},{"key":"6805_CR6","volume":"14","author":"D Rastogi","year":"2022","unstructured":"Rastogi D, Gautam N, Ara Z, Waliullah S, Srivastava RN (2022) Prevalence of abnormal bone-specific alkaline phosphatase in orthopaedic trauma patients: A cross-sectional study from a tertiary trauma centre. Cureus 14:e24264","journal-title":"Cureus"},{"key":"6805_CR7","doi-asserted-by":"publisher","first-page":"sfae093","DOI":"10.1093\/ckj\/sfae093","volume":"17","author":"HS J\u00f8rgensen","year":"2024","unstructured":"J\u00f8rgensen HS, Jes\u00fas Lloret M, Lalayiannis AD, Shroff R, Evenepoel P (2024) Ten tips on how to assess bone health in patients with chronic kidney disease. Clin Kidney J 17:sfae093","journal-title":"Clin Kidney J"},{"key":"6805_CR8","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.3390\/ijms25031843","volume":"25","author":"J Mart\u00edn-V\u00edrgala","year":"2024","unstructured":"Mart\u00edn-V\u00edrgala J, Mart\u00edn-Carro B, Fern\u00e1ndez-Villabrille S, Ruiz-Torres MP, G\u00f3mez-Alonso C, Rodr\u00edguez-Garc\u00eda M, Fern\u00e1ndez-Mart\u00edn JL, Alonso-Montes C, Panizo S, Cannata-And\u00eda JB (2024) Soluble Klotho, a Potential Biomarker of Chronic Kidney Disease-Mineral Bone Disorders Involved in Healthy Ageing: Lights and Shadows. Int J Mol Sci 25:1843","journal-title":"Int J Mol Sci"},{"key":"6805_CR9","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1093\/ckj\/sfaa028","volume":"14","author":"Bouma-de Krijger A, de Roij van Zuijdewijn CLM, Nub\u00e9 MJ, Grooteman MPC, Vervloet MG; CONTRAST Study Group","year":"2021","unstructured":"Bouma-de Krijger A, de Roij van Zuijdewijn CLM, Nub\u00e9 MJ, Grooteman MPC, Vervloet MG; CONTRAST Study Group (2021) Change in FGF23 concentration over time and its association with all-cause mortality in patients treated with haemodialysis or haemodiafiltration. Clin Kidney J 14:891\u2013897","journal-title":"Clin Kidney J"},{"key":"6805_CR10","doi-asserted-by":"publisher","first-page":"531","DOI":"10.3390\/toxins15090531","volume":"15","author":"C Pedreros-Rosales","year":"2023","unstructured":"Pedreros-Rosales C, Jara A, Lorca E, Mezzano S, Pecoits-Filho R, Herrera P (2023) Unveiling the clinical benefits of high-volume hemodiafiltration: Optimizing the removal of medium-weight uremic toxins and beyond. Toxins (Basel) 15:531","journal-title":"Toxins (Basel)"},{"key":"6805_CR11","doi-asserted-by":"publisher","first-page":"2358","DOI":"10.1016\/j.ekir.2021.06.025","volume":"6","author":"D-C Fischer","year":"2021","unstructured":"Fischer D-C, Smith C, De Zan F, Bacchetta J, Bakkaloglu SA, Agbas A, Anarat A, Aoun B, Askiti V, Azukaitis K (2021) Hemodiafiltration is associated with reduced inflammation and increased bone formation compared with conventional hemodialysis in children: the HDF, hearts and heights (3H) study. Kidney Int Reports 6:2358\u20132370","journal-title":"Kidney Int Reports"},{"key":"6805_CR12","doi-asserted-by":"publisher","first-page":"342","DOI":"10.5301\/jn.5000150","volume":"26","author":"L Patrier","year":"2013","unstructured":"Patrier L, Dupuy A-M, Granger Vallee A, Chalabi L, Morena M, Canaud B, Cristol J-P (2013) FGF-23 removal is improved by on-line high-efficiency hemodiafiltration compared to conventional high flux hemodialysis. J Nephrol 26:342\u2013349","journal-title":"J Nephrol"},{"key":"6805_CR13","doi-asserted-by":"publisher","first-page":"315","DOI":"10.5414\/CN108468","volume":"83","author":"F Uhlin","year":"2015","unstructured":"Uhlin F, Magnusson P, Larsson TE, Fernstr\u00f6m A (2015) In the backwater of convective dialysis: decreased 25-hydroxyvitamin D levels following the switch to online hemodiafiltration. Clin Nephrol 83:315\u2013321","journal-title":"Clin Nephrol"},{"key":"6805_CR14","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1016\/j.kint.2019.04.009","volume":"96","author":"D Egli-Spichtig","year":"2019","unstructured":"Egli-Spichtig D, Silva PHI, Glaudemans B, Gehring N, Bettoni C, Zhang MYH, Pastor-Arroyo EM, Sch\u00f6nenberger D, Rajski M, Hoogewijs D (2019) Tumor necrosis factor stimulates fibroblast growth factor 23 levels in chronic kidney disease and non-renal inflammation. Kidney Int 96:890\u2013905","journal-title":"Kidney Int"},{"key":"6805_CR15","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1097\/MNH.0000000000000232","volume":"25","author":"C Francis","year":"2016","unstructured":"Francis C, David V (2016) Inflammation regulates fibroblast growth factor 23 production. Curr Opin Nephrol Hypertens 25:325\u2013332","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"6805_CR16","doi-asserted-by":"publisher","first-page":"287","DOI":"10.5414\/CN108407","volume":"82","author":"F Lima","year":"2014","unstructured":"Lima F, El-Husseini A, Monier-Faugere M-C, David V, Mawad H, Quarles D, Malluche HH (2014) FGF-23 serum levels and bone histomorphometric results in adult patients with chronic kidney disease on dialysis. Clin Nephrol 82:287","journal-title":"Clin Nephrol"},{"key":"6805_CR17","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.xkme.2019.09.007","volume":"2","author":"C Kawabata","year":"2020","unstructured":"Kawabata C, Komaba H, Ishida H, Nakagawa Y, Hamano N, Koizumi M, Kanai G, Wada T, Nakamura M, Fukagawa M (2020) Changes in fibroblast growth factor 23 and soluble klotho levels after hemodialysis initiation. Kidney Med 2:59\u201367","journal-title":"Kidney Med"},{"key":"6805_CR18","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1258\/acb.2012.011274","volume":"49","author":"D-C Fischer","year":"2012","unstructured":"Fischer D-C, Mischek A, Wolf S, Rahn A, Salweski B, Kundt G, Haffner D (2012) Paediatric reference values for the C-terminal fragment of fibroblast-growth factor-23, sclerostin, bone-specific alkaline phosphatase and isoform 5b of tartrate-resistant acid phosphatase. Ann Clin Biochem 49:546\u2013553","journal-title":"Ann Clin Biochem"},{"key":"6805_CR19","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.21608\/ejhm.2021.165176","volume":"83","author":"S Abd Alwahab","year":"2021","unstructured":"Abd Alwahab S, Anwar W, Abd Elnasier M, Aboalfarh ME (2021) Effect of Dialysis Modality on Bone Disease in Patient with End Stage Renal Disease. Egypt J Hosp Med 83:1265\u20131269","journal-title":"Egypt J Hosp Med"},{"key":"6805_CR20","doi-asserted-by":"publisher","first-page":"hcaa052","DOI":"10.1093\/qjmed\/hcaa052.023","volume":"113","author":"HM Elsayed","year":"2020","unstructured":"Elsayed HM, Elsharkawy MM, Kamel CR, Hussein HS, Abdelgawad MA, Abdelsamea MS (2020) Effect of hemodiafiltration on sclerostin level and bone specific alkaline phosphatase in comparison with high flux dialysis. QJM 113:hcaa052-023","journal-title":"QJM"},{"key":"6805_CR21","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/j.kint.2019.05.018","volume":"96","author":"B Czaya","year":"2019","unstructured":"Czaya B, Faul C (2019) FGF23 and inflammation\u2014a vicious coalition in CKD. Kidney Int 96:813\u2013815","journal-title":"Kidney Int"},{"key":"6805_CR22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12882-020-01957-9","volume":"21","author":"MAA Ibrahim","year":"2020","unstructured":"Ibrahim MAA, ElHakim IZ, Soliman D, Mubarak MA, Said RM (2020) Online hemodiafilteration use in children: a single center experience with a twist. BMC Nephrol 21:306","journal-title":"BMC Nephrol"},{"key":"6805_CR23","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1681\/ASN.2018100990","volume":"30","author":"R Shroff","year":"2019","unstructured":"Shroff R, Smith C, Ranchin B, Bayazit AK, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, A\u011fba\u015f A, Aitkenhead H (2019) Effects of hemodiafiltration versus conventional hemodialysis in children with ESKD: the HDF, heart and height study. J Am Soc Nephrol 30:678\u2013691","journal-title":"J Am Soc Nephrol"},{"key":"6805_CR24","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1007\/s11255-012-0324-8","volume":"45","author":"RC Francisco","year":"2013","unstructured":"Francisco RC, Aloha M, Ram\u00f3n PS (2013) Effects of high-efficiency postdilution online hemodiafiltration and high-flux hemodialysis on serum phosphorus and cardiac structure and function in patients with end-stage renal disease. Int Urol Nephrol 45:1373\u20131378","journal-title":"Int Urol Nephrol"},{"key":"6805_CR25","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1093\/ndt\/gfp565","volume":"25","author":"M Fischbach","year":"2010","unstructured":"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\u2013873","journal-title":"Nephrol Dial Transplant"}],"container-title":["Pediatric Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-025-06805-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00467-025-06805-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-025-06805-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T15:05:02Z","timestamp":1757171102000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00467-025-06805-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["6805"],"URL":"https:\/\/doi.org\/10.1007\/s00467-025-06805-2","relation":{},"ISSN":["0931-041X","1432-198X"],"issn-type":[{"value":"0931-041X","type":"print"},{"value":"1432-198X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]},"assertion":[{"value":"28 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Our study followed the Helsinki Declarations and was approved by the Research Ethics Committee, Faculty of Medicine, Ain Shams University (FWA 000017585; FMASU: R 124\/2024).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from the legal guardians of all patients involved in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}