Al-Chalabi Saif, Sinha Smeeta, Kalra Philip A, Evans Dawn, Green Darren, Schurgers Leon, Poulikakos Dimitrios
Donal O'Donoghue Renal Research Centre, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK,
Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK,
Blood Purif. 2025 Apr 21:1-13. doi: 10.1159/000545745.
In contrast to high-flux dialysis (HFD) membranes, medium cut-off membranes (MCO) can potentially remove a wide range of middle molecules. Our study aimed to compare the clearance rate (CR) of fibroblast growth factor 23 (FGF-23) and other selected inflammatory cytokines between medium MCO and HFD membranes and investigate the intrasubject stability of these biomarkers.
This prospective randomised case-crossover study recruited 20 adult patients who were randomised into two groups: group A: to start with 1 week of thrice-weekly dialysis using HFD membrane followed by a 3-week washout period and then 1 week of dialysis with an MCO membrane. Group B followed the reverse sequence. Blood samples were taken before and after each dialysis session for the analysis of the assessed biomarkers (FGF-23, interleukin-6 [IL-6], interleukin-18 [IL-18], high-sensitivity C-reactive protein [hsCRP], and dephosphorylated uncarboxylated matrix Gla protein [dp-ucMGP]). Wilcoxon signed rank and paired t tests were used for comparison between the membranes. One-way repeated measures ANOVA or Friedman tests were used for the intrasubject stability of the biomarkers.
The use of both MCO and HFD membranes resulted in a significant reduction of FGF-23 levels and other selected inflammatory cytokines. However, there was no significant difference in the CR: FGF-23 (0.31 vs. 0.23], p = 0.242), IL-6 (0.19 vs. 0.12, p = 0.215), IL-18 (-0.05 vs. -0.03, p = 0.704), dp-ucMGP (0.33 vs. 0.33, p = 0.903), and hsCRP (-0.05 vs. -0.08, p = 0.107). There was no significant intrasubject variability for all assessed biomarkers except in pre-dialysis high hsCRP levels when using HFD membrane.
The use of both MCO and HFD membranes resulted in a significant reduction of FGF-23 levels and other selected inflammatory cytokines. However, the MCO membrane did not demonstrate a significant advantage over the HFD in the short term. There was no significant intrasubject variability for all assessed biomarkers apart from hsCRP.
与高通量透析（HFD）膜不同，中截留分子量膜（MCO）有可能清除多种中分子物质。我们的研究旨在比较中MCO膜和HFD膜对成纤维细胞生长因子23（FGF-23）及其他选定炎性细胞因子的清除率（CR），并研究这些生物标志物在个体内的稳定性。
这项前瞻性随机病例交叉研究招募了20名成年患者，随机分为两组：A组：开始时每周进行3次HFD膜透析1周，随后有3周的洗脱期，然后用MCO膜透析1周。B组采用相反的顺序。在每次透析前后采集血样，用于分析评估的生物标志物（FGF-23、白细胞介素-6 [IL-6]、白细胞介素-18 [IL-18]、高敏C反应蛋白[hsCRP]和去磷酸化未羧化基质Gla蛋白[dp-ucMGP]）。采用Wilcoxon符号秩和检验及配对t检验对两种膜进行比较。采用单向重复测量方差分析或Friedman检验评估生物标志物在个体内的稳定性。
使用MCO膜和HFD膜均导致FGF-23水平及其他选定炎性细胞因子显著降低。然而，清除率无显著差异：FGF-23（0.31对0.23，p = 0.242）、IL-6（0.19对0.12，p = 0.215）、IL-18（-0.05对-0.03，p = 0.704）、dp-ucMGP（0.33对0.33，p = 0.903）和hsCRP（-0.05对-0.08，p = 0.107）。除使用HFD膜时透析前hsCRP水平较高外，所有评估的生物标志物在个体内均无显著变异性。
使用MCO膜和HFD膜均导致FGF-23水平及其他选定炎性细胞因子显著降低。然而，短期内MCO膜相对于HFD膜并未显示出显著优势。除hsCRP外，所有评估的生物标志物在个体内均无显著变异性。
