#987 A randomized prospective crossover study on the effects of medium cut-off membranes on FGF-23 and inflammatory mediators in patients receiving regular haemodialysis

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Abstract Background and Aims High-flux dialysis (HFD) membranes effectively remove small molecules during haemodialysis but have limited capacity in clearing middle molecules that may contribute to the uraemic milieu. Medium cut-off membranes (MCO) have the potential of removing 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. Method This prospective randomised case-crossover study recruited adult patients receiving regular haemodialysis. Twenty patients were randomised into two groups: Group A: to start with 1 week of thrice-weekly dialysis using HFD membrane followed by a 3-weeks washout period and then 1 week of dialysis with an MCO membrane; Group B, to start with 1 week of thrice-weekly dialysis using MCO membrane followed by a 3-weeks washout period then 1 week of dialysis with HFD membrane. Blood samples were taken before and after each dialysis session for analysis of the assessed biomarkers (FGF-23, interlukin-6 [IL-6], interlukin-18 [IL-18], high-sensitivity C-reactive protein [hsCRP] and dephosphorylated uncarboxylated matrix Gla protein [dp-ucMGP]). Average values over the 3 sessions in each arm were used for comparison between the membranes using Wilcoxon signed rank test and paired-t test depending on the distribution of the data. One-way repeated measures ANOVA or Friedman Repeated Measures Analysis of Variance tests were used for the intrasubject stability of the biomarkers depending on the distribution of the data. Results There was no significant difference in the CR when using MCO and HFD membranes for the assessed biomarkers: 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 MCO membranes for a short period did not substantially reduce FGF-23 levels or other selected inflammatory cytokines. There was no significant intrasubject variability for all assessed biomarkers apart from hsCRP.

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