title: Short daily hemodialysis is associated with lower plasma FGF23 levels when compared with conventional hemodialysis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics at Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Zaritsky
authors.forename: Anjay
authors.initials: A
authors.lastname: Rastogi
authors.forename: George
authors.initials: G
authors.lastname: Fischmann
authors.forename: Jieshi
authors.initials: J
authors.lastname: Yan
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kleinman
authors.forename: Georgina
authors.initials: G
authors.lastname: Chow
authors.forename: Barbara
authors.initials: B
authors.lastname: Gales
authors.forename: Isidro B
authors.initials: IB
authors.lastname: Salusky
authors.forename: Katherine
authors.initials: K
authors.lastname: Wesseling-Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood* / Q000172:deficiency; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: FGF23; dialysis adequacy; hemodialysis