FGF-23 removal is improved by on-line high-efficiency hemodiafiltration compared to conventional high flux hemodialysis

Background: Reducing circulating levels of fibroblast growth factor-23 (FGF-23) in patients on renal replacement therapy (RRT) could appear as an appealing approach for cardiovascular events prevention. The purpose of our study was to compare the clearance of FGF-23 between high flux hemodialysis (HD) and online hemodiafiltration (OL-HDF) procedures. Methods: Fifty-three patients were included in the HD group while 32 patients were included in the OL-HDF group. Serum pre- and post-dialysis FGF-23 levels were measured using a 2nd generation Human FGF-23 (C-Term) ELISA kit. Results: Mean FGF-23 reduction rates were significantly higher in OL-HDF (55.7 +/- 25.2%) versus HD (36.2 +/- 28.6%) groups (P=.0001), as were calculated FGF-23 clearances (P=.015) and Kt/V-FGF-23 (P=.001). Overall, post-treatment FGF-23 levels were significantly lower than pre-treatment values in both groups (P<.01). Conclusions: OL-HDF achieves higher FGF-23 removal over high flux HD.