title: Influence of high-flux hemodialysis and hemodiafiltration on serum C-terminal agrin fragment levels in end-stage renal disease patients.
abstract: 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.
authors.affiliation: Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany. Electronic address: dominik.steubl@gmx.de.
authors.forename: Dominik
authors.initials: D
authors.lastname: Steubl
authors.affiliation: Neurotune AG, Schlieren-Zurich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hettwer
authors.affiliation: Neurotune AG, Schlieren-Zurich, Switzerland.
authors.forename: Pius
authors.initials: P
authors.lastname: Dahinden
authors.affiliation: Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, München, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Wolf
authors.affiliation: Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, München, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Luppa
authors.affiliation: Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Carsten A
authors.initials: CA
authors.lastname: Wagner
authors.affiliation: Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany.
authors.forename: Claudius
authors.initials: C
authors.lastname: Küchle
authors.affiliation: Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmaderer
authors.affiliation: Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Renders
authors.affiliation: Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
authors.affiliation: Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Roos
mesh_terms: D000328:Adult; D000368:Aged; D018171:Agrin / Q000097:blood / Q000235:genetics / Q000378:metabolism*; D015415:Biomarkers; D015314:Dialysis Solutions / Q000737:chemistry; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D018171:Agrin; D015415:Biomarkers; D015314:Dialysis Solutions