Ev hemodiyalizi ve merkez hemodiyalizinde serum fibroblast büyüme faktörü 23 (FGF23) seviyeleri ve Kronik Böbrek Hastalığı-Mineral ve Kemik Bozukluğu (CKD- MBD) parametreleri üzerindeki etkilerinin karşılaştırılması

Öz

Amaç: Bu çalışma, ev hemodiyalizi (HHD) ve merkez hemodiyalizi (CHD) tedavisi altındaki hastalarda serum fibroblast büyüme faktörü 23 (FGF23) seviyelerini ve Kronik Böbrek Hastalığı-Mineral ve Kemik Bozukluğu (CKD-MBD) parametrelerini karşılaştırmayı amaçlamaktadır. Gereç ve yöntem: Çalışmaya 18 yaş üstü, en az 6 aydır diyaliz tedavisi alan 42 hasta dahil edildi. Hastalar, HHD (n=17) ve CHD (n=25) olmak üzere iki gruba ayrıldı. Demografik veriler, diyaliz süresi, biyokimyasal parametreler (serum fosfor, kalsiyum, parathormon (PTH), albümin, hemoglobin, FGF23 vb.) ve ilaç kullanımı kaydedildi. Serum FGF23 seviyeleri, haftanın ortasında HD seansı öncesi alınan kan örneklerinden ELISA yöntemi ile ölçüldü. Gruplar arasındaki frekans dağılımları yüzdeli olarak ifade edildi ve ki-kare testi ile karşılaştırıldı. Bulgular: HHD grubunda Kt/V değerleri daha yüksek (2,4±0,1 vs. 1,6±0,1) ve serum fosfor seviyeleri daha düşük (4,1±1,1 vs. 5,0±1,2 mg/dL) bulundu. FGF23 seviyeleri HHD grubunda daha düşük olmasına rağmen, iki grup arasında istatistiksel olarak anlamlı fark tespit edilmedi (383±423 vs. 441±480 pg/ml, p=0,05). EPO kullanımı HHD grubunda belirgin şekilde daha düşük bulundu (%47 vs. %92, p=0,001). Sonuç: HHD, CHD'ye kıyasla daha iyi fosfor kontrolü ve daha düşük EPO gereksinimi ile ilişkilendirildi. FGF23 seviyelerinin HHD’de daha düşük olması, bu modalitenin CKD-MBD, kardiyovasküler sonuçlar ve mortalite açısından avantaj sağlayabileceğini düşündürmektedir. Ancak, bu bulguların daha geniş hasta gruplarında prospektif çalışmalar ile desteklenmesi gerekmektedir.

Anahtar Kelimeler

• FGF23
• ev hemodiyalizi
• merkez hemodiyalizi
• kronik böbrek hastalığı
• diyali

Comparison of serum fibroblast growth factor 23 (FGF23) levels and Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) parameters in home hemodialysis and center hemodialysis

Öz

Purpose: This study aims to compare serum fibroblast growth factor 23 (FGF23) levels and chronic kidney disease-mineral and bone disorder (CKD-MBD) parameters in patients undergoing home hemodialysis (HHD) and center hemodialysis (CHD). Materials and methods: A total of 42 patients over 18 years old who had been receiving dialysis treatment for at least six months were included in the study. The patients were divided into two groups: HHD (n=17) and CHD (n=25). Demographic data, dialysis duration, biochemical parameters (serum phosphorus, calcium, parathyroid hormone (PTH), albumin, hemoglobin, FGF23, etc.), and medication use were recorded. Serum FGF23 levels were measured using an enzyme-linked immunosorbent assay (ELISA) method from blood samples taken before midweek HD sessions. Frequency distributions were expressed as percentages and compared using the chi-square test. Results: The Kt/V values were higher in the HHD group (2.4±0.1 vs. 1.6±0.1), while serum phosphorus levels were lower (4.1±1.1 vs. 5.0±1.2 mg/dL). Although FGF23 levels were lower in the HHD group, the difference was not statistically significant (383±423 vs. 441±480 pg/mL, p=0.05). Erythropoietin (Epo) usage was significantly lower in the HHD group (47% vs. 92%, p=0.001). Conclusion: HHD was associated with better phosphorus control and a reduced requirement for EPO compared to CHD. The lower FGF23 levels in HHD suggest that this modality may offer advantages in CKD- MBD, cardiovascular outcomes, and mortality. However, these findings need to be supported by prospective studies involving larger patient populations.

Anahtar Kelimeler

• FGF23
• home hemodialysis
• center hemodialysis
• chronic kidney disease
• dialysis

Kaynakça

1. 1. Trinh E, Chan CT. The Rise, Fall, and Resurgence of Home Hemodialysis. Semin Dial. 2017;30(2):174-180. doi:10.1111/sdi.12572
2. 2. Lacson E Jr, Xu J, Suri RS, et al. Survival with three-times weekly in-center nocturnal versus conventional hemodialysis. J Am Soc Nephrol. 2012;23(4):687-695. doi:10.1681/ASN.2011070674
3. 3. Ok E, Duman S, Asci G, et al. Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-centre haemodialysis: a prospective, case-controlled study. Nephrol Dial Transplant. 2011;26(4):1287-1296. doi:10.1093/ndt/gfq724
4. 4. Mucsi I, Hercz G, Uldall R, Ouwendyk M, Francoeur R, Pierratos A. Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis. Kidney Int. 1998;53(5):1399-1404. doi:10.1046/j.1523-1755.1998.00875.x
5. 5. Goodkin DA, Bragg Gresham JL, Koenig KG, et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;14(12):3270-3277. doi:10.1097/01.asn.0000100127.54107.57
6. 6. Bugeja A, Dacouris N, Thomas A, et al. In-center nocturnal hemodialysis: another option in the management of chronic kidney disease. Clin J Am Soc Nephrol. 2009;4(4):778-783. doi:10.2215/CJN.05221008
7. 7. de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009;302(16):1782-1789. doi:10.1001/jama.2009.1488
8. 8. Martin A, David V, Quarles LD. Regulation and function of the FGF23/klotho endocrine pathways. Physiol Rev. 2012;92(1):131-155. doi:10.1152/physrev.00002.2011

9. 9. Shimada T, Urakawa I, Yamazaki Y, et al. FGF-23 transgenic mice demonstrate hypophosphatemic rickets with reduced expression of sodium phosphate cotransporter type IIa. Biochem Biophys Res Commun. 2004;314(2):409-414. doi:10.1016/j.bbrc.2003.12.1021
10. 10. Galitzer H, Ben Dov IZ, Silver J, Naveh Many T. Parathyroid cell resistance to fibroblast growth factor 23 in secondary hyperparathyroidism of chronic kidney disease. Kidney Int. 2010;77(3):211-218. doi:10.1038/ki.2009.464
11. 11. Gutiérrez OM, Mannstadt M, Isakova T, et al. Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med. 2008;359(6):584-592. doi:10.1056/NEJMoa0706130
12. 12. Nakanishi S, Kazama JJ, Nii Kono T, et al. Serum fibroblast growth factor-23 levels predict the future refractory hyperparathyroidism in dialysis patients. Kidney Int. 2005;67(3):1171-1178. doi:10.1111/j.1523-1755.2005.00184.x
13. 13. Isakova T, Xie H, Yang W, et al. Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. JAMA. 2011;305(23):2432-2439. doi:10.1001/jama.2011.826
14. 14. Lacson E Jr, Wang W, Lester K, Ofsthun N, Lazarus JM, Hakim RM. Outcomes associated with in-center nocturnal hemodialysis from a large multicenter program. Clin J Am Soc Nephrol. 2010;5(2):220-226. doi:10.2215/CJN.06070809
15. 15. Ferrari SL, Bonjour JP, Rizzoli R. Fibroblast growth factor-23 relationship to dietary phosphate and renal phosphate handling in healthy young men. J Clin Endocrinol Metab. 2005;90(3):1519-1524. doi:10.1210/jc.2004-1039
16. 16. Lavi Moshayoff V, Wasserman G, Meir T, Silver J, Naveh Many T, PTH.increases FGF23 gene expression and mediates the high-FGF23 levels of experimental kidney failure: a bone parathyroid feedback loop. Am J Physiol Renal Physiol. 2010;299:F882-889. doi: 10.1152/ajprenal.00360.2010
17. 17. Ok E, Duman S, Asci G, et al. Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-centre haemodialysis: a prospective, case-controlled study. Nephrol Dial Transplant. 2011;26(4):1287-1296. doi:10.1093/ndt/gfq724