title: Effect of High-Flux Dialysis on Circulating FGF-23 Levels in End-Stage Renal Disease Patients: Results from a Randomized Trial.
abstract: BACKGROUND
  In patients undergoing maintenance hemodialysis (HD), increased levels of circulating fibroblast growth factor-23 (FGF-23) are independently associated with cardiovascular events and mortality. Interventional strategies aiming to reduce levels of FGF-23 in HD patients are of particular interest. The purpose of the current study was to compare the impact of high-flux versus low-flux HD on circulating FGF-23 levels.
  
  
  METHODS
  We conducted a post-hoc analysis of the MINOXIS study, including 127 dialysis patients randomized to low-flux (n = 62) and high-flux (n = 65) HD for 52 weeks. Patients with valid measures for FGF-23 investigated baseline and after 52 weeks were included.
  
  
  RESULTS
  Compared to baseline, a significant increase in FGF-23 levels after one year of low-flux HD was observed (Delta plasma FGF-23: +4026 RU/ml; p < 0.001). In contrast, FGF-23 levels remained stable in the high flux group (Delta plasma FGF-23: +373 RU/ml, p = 0.70). The adjusted difference of the absolute change in FGF-23 levels between the two treatment groups was statistically significant (p < 0.01).
  
  
  CONCLUSIONS
  Over a period of 12 months, high-flux HD was associated with stable FGF-23 levels, whereas the low-flux HD group showed an increase of FGF-23. However, the implications of the different FGF 23 time-trends in patients on high flux dialysis, as compared to the control group, remain to be explored in specifically designed clinical trials.
  
  
  BACKGROUND
  German Clinical Trials Register (DRKS) DRKS00007612.
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Nephrology and Hypertension, University Hospital, Erlangen-Nürnberg, Germany.
authors.forename: Markus P
authors.initials: MP
authors.lastname: Schneider
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany.
authors.forename: Detlef H
authors.initials: DH
authors.lastname: Krieter
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty, Mannheim, Germany; BGStats Consulting, Vienna, Austria.
authors.forename: Bernd
authors.initials: B
authors.lastname: Genser
authors.affiliation: Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria.
authors.forename: Hubert
authors.initials: H
authors.lastname: Scharnagl
authors.affiliation: Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stojakovic
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Drechsler
mesh_terms: D000368:Aged; D015519:Bone Density; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome
chemical_list: C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23