Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany.
Neurotune AG, Schlieren-Zurich, Switzerland.
Transl Res. 2014 Nov;164(5):392-9. doi: 10.1016/j.trsl.2014.05.005. Epub 2014 May 16.
C-terminal agrin fragment (CAF, 22 kDa) has been shown to be a promising new rapid biomarker for kidney function. This study evaluated the influence of hemodialysis (HD) and hemodiafiltration (HDF) treatment on serum CAF concentrations in patients with end-stage renal disease (ESRD). A total of 36 patients with ESRD undergoing chronic HD/HDF treatment were enrolled (21 high-flux-HD/Fx60 membrane, 7 high-flux-HD/Elisio19H membrane, and 8 HDF/Elisio19H membrane). On a midweek session, blood samples were obtained before, at halftime, and post-treatment. Dialysate samples were obtained 4 times during treatment. Serum and dialysate CAF, cystatin C, urea, and creatinine concentrations were measured. Reduction ratios (RRs), total solute removal, overall dialytic clearance, and instantaneous dialytic clearance at halftime were calculated and compared. Although HD/Elisio19H and HDF/Elisio19H treatments significantly reduced CAF concentrations (RR 46.6 ± 9.1% and 57.6 ± 11.7%, respectively, P = 0.018 and P = 0.001), HD/Fx60 treatment did not remove CAF from serum (RR 2.4 ± 15.4%, P = 0.25), there was no relevant CAF detection in dialysate. In the HD/Fx60 group, the RR of CAF was significantly lower compared with cystatin C, urea, and creatinine, in which significant removal was detected (37.9 ± 14.8%, 65.0 ± 10.7%, and 56.0 ± 9.8%, respectively, P < 0.001). CAF is a new biomarker for kidney function whose serum concentration is not influenced by conventional high-flux HD using Fx60 membrane. It might therefore represent a promising dialysis-independent biomarker for evaluation of kidney function, for example, in acute kidney failure.
C 端神经胶质细胞衍生因子片段（CAF，22 kDa）已被证明是一种很有前途的新的肾功能快速生物标志物。本研究评估了血液透析（HD）和血液透析滤过（HDF）治疗对终末期肾病（ESRD）患者血清 CAF 浓度的影响。共纳入 36 例接受慢性 HD/HDF 治疗的 ESRD 患者（21 例使用高通量-Fx60 膜，7 例使用高通量-Elisio19H 膜，8 例使用 HDF/Elisio19H 膜）。在每周中间的一次治疗中，在治疗前、治疗中途和治疗后采集血样。在治疗期间 4 次采集透析液样本。测量血清和透析液 CAF、胱抑素 C、尿素和肌酐浓度。计算并比较减少率（RR）、总溶质清除率、整体透析清除率和治疗中途的瞬时透析清除率。虽然 HD/Elisio19H 和 HDF/Elisio19H 治疗显著降低了 CAF 浓度（RR 分别为 46.6 ± 9.1%和 57.6 ± 11.7%，P=0.018 和 P=0.001），但 HD/Fx60 治疗不能从血清中清除 CAF（RR 2.4 ± 15.4%，P=0.25），透析液中也没有相关的 CAF 检测到。在 HD/Fx60 组中，CAF 的 RR 明显低于胱抑素 C、尿素和肌酐的 RR，这些物质的 RR 明显降低（分别为 37.9 ± 14.8%、65.0 ± 10.7%和 56.0 ± 9.8%，P<0.001）。CAF 是一种新的肾功能生物标志物，其血清浓度不受使用 Fx60 膜的常规高通量 HD 的影响。因此，它可能是一种有前途的、与透析无关的肾功能评估的生物标志物，例如在急性肾衰竭中。
