FGF23 clearance in hemodialysis patients

In Chronic Kidney Disease (CKD), fibroblast growth factor 23 (FGF23) acts as a cardiovascular toxin by contributing to hypertension, vascular calcification, and left ventricular hypertrophy, leading to increased cardiovascular risk and mortality (1). 

FGF23 clearance in hemodialysis patients

In a recent study researchers explored whether the use of different dialysis membranes result in a reduction of FGF23 and other inflammatory cytokine levels (IL-6, IL-18, dp-ucMGP, and hsCRP) in hemodialysis patients.

A Randomised Prospective Crossover Study on the Effects of Medium Cut-Off Membranes on FGF-23 and Inflammatory Mediators in Patients Receiving Regular Haemodialysis. Al-Chalabi S, et al., 2025. Blood Purif.

Abstract

Introduction: In contrast to high-flux dialysis (HFD) membranes, medium cut-off membranes (MCO) can potentially remove a wide range of middle molecules. Our study aimed to compare the clearance rate (CR) of fibroblast growth factor 23 (FGF-23) and other selected inflammatory cytokines between medium MCO and HFD membranes and investigate the intrasubject stability of these biomarkers.

Methods: This prospective randomised case-crossover study recruited 20 adult patients who were randomised into two groups: group A: to start with 1 week of thrice-weekly dialysis using HFD membrane followed by a 3-week washout period and then 1 week of dialysis with an MCO membrane. Group B followed the reverse sequence. Blood samples were taken before and after each dialysis session for the analysis of the assessed biomarkers (FGF-23, interleukin-6 [IL-6], interleukin-18 [IL-18], high-sensitivity C-reactive protein [hsCRP], and dephosphorylated uncarboxylated matrix Gla protein [dp-ucMGP]). Wilcoxon signed rank and paired t tests were used for comparison between the membranes. One-way repeated measures ANOVA or Friedman tests were used for the intrasubject stability of the biomarkers.

Results: The use of both MCO and HFD membranes resulted in a significant reduction of FGF-23 levels and other selected inflammatory cytokines. However, there was no significant difference in the CR: FGF-23 (0.31 vs. 0.23], p = 0.242), IL-6 (0.19 vs. 0.12, p = 0.215), IL-18 (-0.05 vs. -0.03, p = 0.704), dp-ucMGP (0.33 vs. 0.33, p = 0.903), and hsCRP (-0.05 vs. -0.08, p = 0.107). There was no significant intrasubject variability for all assessed biomarkers except in pre-dialysis high hsCRP levels when using HFD membrane.

Conclusion: The use of both MCO and HFD membranes resulted in a significant reduction of FGF-23 levels and other selected inflammatory cytokines. However, the MCO membrane did not demonstrate a significant advantage over the HFD in the short term. There was no significant intrasubject variability for all assessed biomarkers apart from hsCRP.

 

BIOMEDICA´s FGF23 and IL-6 ELISA Assay Kits were successfully utilized in the study:

 

FGF23 (C-terminal) multi-matrix ELISA Kit | BI-20702

• Instructions for use
• Validation data file
• Citations

 

IL-6 (Interleukin-6) ELISA Kit | BI-IL6

• Instructions for use
• Validation data file
• Citations

 

 

Related Products:

-Intact FGF23 ELISA Kit | BI-20700

–NT-proBNP ELISA | SK-1204

 

Literature

1. FGF23 and Phosphate-Cardiovascular Toxins in CKD. Toxins (Basel). Vogt I, Haffner D, Leifheit-Nestler M. 2019 Nov 6;11(11):647. doi: 10.3390/toxins11110647. PMID: 31698866; PMCID: PMC6891626.
2. A Randomised Prospective Crossover Study on the Effects of Medium Cut-Off Membranes on FGF-23 and Inflammatory Mediators in Patients Receiving Regular Haemodialysis. Al-Chalabi S, Sinha S, Kalra PA, Evans D, Green D, Schurgers L, Poulikakos D. Blood Purif. 2025 Apr 21:1-13. doi: 10.1159/000545745. Epub ahead of print. PMID: 40258362; PMCID: PMC12105827.