Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy.
Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
J Nephrol. 2018 Jun;31(3):429-433. doi: 10.1007/s40620-017-0393-y. Epub 2017 Apr 11.
Serum levels of 32 kDa-phosphaturic hormone fibroblast growth factor 23 (FGF23) rise early in renal failure in order to keep phosphatemia within the normal range; however, this compensatory mechanism itself contributes to chronic kidney disease-mineral bone disorder. High FGF23 is also associated to left ventricular hypertrophy, vascular calcifications and thus increased cardiovascular risk. The aim of this pilot pre-post study was to evaluate the effects of a single hemodiafiltration session with acetate-free biofiltration (AFB) on FGF23 serum levels.
Nine hemodialysis patients were enrolled; sessions were performed using the Integra monitor (Hospal, Bologna, Italy) and a polyacrylonitrile membrane. Peripheral venous blood samples were taken before (pre-HD), at mid- and after treatment (post-HD); dialysate samples were collected by the Quantiscan™ monitoring system. FGF23 was measured by a human FGF-23 ELISA kit. Mid- and post-HD values were corrected for hemoconcentration.
Pre-HD FGF23 levels positively correlated with dialysis vintage (r = 0.7192; p = 0.0443). They were significantly reduced by the hemodialysis session (from 2.38 ± 1.80 to 1.15 ± 1.21 ng/ml, p = 0.0171) with a reduction ratio of 52.55 ± 28.76%. FGF23 was detected in the dialysate samples.
FGF23 underwent a significant reduction during AFB. Such removal was greater than that induced by conventional hemodialysis as reported in the literature (19%-decrease using modified cellulosic membranes). This difference may be attributed to the ability of AFB hemodiafiltration to efficiently remove middle molecules by convection. Whether a better clearance of FGF23 during hemodialysis may result in improved cardiovascular outcomes in the long term needs to be confirmed by randomized controlled trials.
血清 32kDa 磷调节激素成纤维细胞生长因子 23（FGF23）在肾衰竭早期升高，以使血磷保持在正常范围内；然而，这种代偿机制本身会导致慢性肾脏病-矿物质和骨异常。高 FGF23 还与左心室肥厚、血管钙化有关，从而增加心血管风险。本预-后研究的目的是评估单次无醋酸盐生物滤过（AFB）血液透析对 FGF23 血清水平的影响。
纳入 9 名血液透析患者；使用 Integra 监测仪（Hospal，博洛尼亚，意大利）和聚丙烯腈膜进行治疗。在治疗前（HD 前）、治疗中和治疗后（HD 后）采集外周静脉血样；使用 Quantiscan™监测系统收集透析液样本。通过人 FGF-23 ELISA 试剂盒测量 FGF23。校正血液浓缩后，计算 HD 中和 HD 后的 FGF23 值。
HD 前 FGF23 水平与透析龄呈正相关（r = 0.7192；p = 0.0443）。与透析前相比，血液透析治疗后 FGF23 水平显著降低（从 2.38 ± 1.80 降至 1.15 ± 1.21ng/ml，p = 0.0171），降低率为 52.55 ± 28.76%。在透析液样本中检测到 FGF23。
在 AFB 过程中，FGF23 显著减少。这种清除率大于文献报道的常规血液透析所诱导的清除率（使用改良纤维素膜时减少 19%）。这种差异可能归因于 AFB 血液透析滤过通过对流有效清除中分子的能力。在长期内，血液透析过程中 FGF23 的清除率提高是否会导致心血管预后改善，需要通过随机对照试验来证实。
