title: Acetate-free biofiltration to remove fibroblast growth factor 23 in hemodialysis patients: a pilot study.
abstract: 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.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Cernaro
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lucisano
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Canale
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Bruzzese
authors.affiliation: Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Caccamo
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costantino
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Buemi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, AOU G. Martino PAD C, Via Consolare Valeria, 98100, Messina, Italy. santisi@hotmail.com.
authors.forename: Domenico
authors.initials: D
authors.lastname: Santoro
mesh_terms: D000085:Acetates; D000180:Acrylic Resins; D000368:Aged; D015314:Dialysis Solutions / Q000737:chemistry; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000032:analysis / Q000097:blood*; D017583:Hemodiafiltration / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D000085:Acetates; D000180:Acrylic Resins; D015314:Dialysis Solutions; C000717427:FGF23 protein, human; C010504:polyacrylonitrile; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Acetate-free biofiltration (AFB); Fibroblast growth factor 23 (FGF23); Hemodiafiltration