Zaritsky Joshua, Rastogi Anjay, Fischmann George, Yan Jieshi, Kleinman Kenneth, Chow Georgina, Gales Barbara, Salusky Isidro B, Wesseling-Perry Katherine
Department of Pediatrics at Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA.
Nephrol Dial Transplant. 2014 Feb;29(2):437-41. doi: 10.1093/ndt/gft382. Epub 2013 Sep 5.
The utilization of short-term daily hemodialysis has increased over the last few years, but little is known on its effects on the control of serum phosphate and fibroblast growth factor 23 (FGF23) levels.
We therefore performed a cross-sectional study to compare FGF23 levels as well as other biochemical variables between 24 patients undergoing short daily hemodialysis using the NxStage System® and 54 patients treated with conventional in-center hemodialysis. FGF23 levels were measured using the second-generation Immutopics® C-terminal assay.
Short daily hemodialysis patients were younger than patients on conventional hemodialysis but there were no differences between groups in the duration of end-stage renal disease nor in the number of patients with residual renal function. A greater number of short daily hemodialysis patients received vitamin D sterol therapy than did conventional in-center hemodialysis patients while there were no differences in the use of different phosphate binders and calcimimetic therapy between groups. Overall serum calcium, phosphorus and intact parathyroid hormone levels were similar between groups. While serum phosphorus levels correlated with FGF23 concentrations in each group separately [r=0.522 (P<0.01) and r=0.42 (P<0.01) in short daily and conventional in-center hemodialysis, respectively], FGF23 levels were lower [823 RU/mL (263, 2169)] in the patients receiving short daily hemodialysis than in patients treated with conventional hemodialysis [2521 RU/mL (909, 5556)] (P<0.01 between groups).
These findings demonstrate that FGF23 levels are significantly lower in short daily hemodialysis patients and suggest that FGF23 levels may be a more sensitive biomarker of cumulative phosphate burden than single or multiple serum phosphorus determinations in patients treated with hemodialysis.
在过去几年中，短期每日血液透析的应用有所增加，但关于其对血清磷和成纤维细胞生长因子23（FGF23）水平控制的影响知之甚少。
因此，我们进行了一项横断面研究，以比较24例使用NxStage System®进行短期每日血液透析的患者与54例接受传统中心血液透析治疗的患者的FGF23水平以及其他生化变量。使用第二代Immutopics® C末端检测法测量FGF23水平。
短期每日血液透析患者比传统血液透析患者年轻，但两组在终末期肾病病程以及残余肾功能患者数量方面没有差异。接受维生素D固醇治疗的短期每日血液透析患者数量多于传统中心血液透析患者，而两组在不同磷结合剂和拟钙剂治疗的使用上没有差异。两组的总体血清钙、磷和完整甲状旁腺激素水平相似。虽然每组中血清磷水平分别与FGF23浓度相关[r=0.522（P<0.01）和r=0.42（P<0.01），分别在短期每日和传统中心血液透析中]，但接受短期每日血液透析的患者的FGF23水平[823 RU/mL（263，2169）]低于接受传统血液透析的患者[2521 RU/mL（909，5556）]（组间P<0.01）。
这些发现表明，短期每日血液透析患者的FGF23水平显著较低，并表明在接受血液透析治疗的患者中，FGF23水平可能比单次或多次血清磷测定更能敏感地反映累积磷负荷的生物标志物。
