ABSTRACT
Objective To observe the effect of high flux hemodialysis (HFHD) combined with artificial kidney on fibroblast growth factor-23 (FGF-23) in patients with maintenance hemodialysis (MHD). Methods Eighty cases who regularly carried out long-term HFHD in nephrology blood purification center of NO.85 Hospital of PLA were enrolled. All the patients firstly received HFHD alone for 1 month, and then according to random principle, they could receive HFHD followed by hemoperfusion (HP) for treatment (HFHD+HP group) or HP followed by HFHD for treatment (HP+HFHD group). These two types of treatment were respectively carried out for 3 months, and then exchanged to proceed the procedure, the interval of exchange being 1 month (in this month, the two groups of patients all underwent simple HFHD treatment). The therapeutic course was 8 months including 2 cycles. The serum samples were taken from patients undergoing simple HFHD before and after the first month of blood purification, and patients in HFHD+HP group and HP+HFHD group before and after the last month for determination of serum creatinine (SCr), calcium, phosphorus, parathyroid hormone (iPTH), FGF-23 levels. Results The SCr level in HFHD + HP group before hemodialysis was significantly lower than that in simple HFHD group (μmol/L:773.45±212.23 vs. 803.27±192.47, P0.05). After hemodialysis, the serum iPTH, FGF-23 were dropped significantly in HFHD + HP and HP + HFHD groups compared with those in simple HFHD group (P 0.05). But the levels of serum phosphorus, iPTH, and FGF-23 in HFHD+HP group were significantly lower than those of HP+HFHD group [serum phosphorus (mmol/L):1.47±0.22 vs. 1.60±0.23, iPTH (μg/L):490.12±145.23 vs. 516.34±165.75, FGF-23 (μg/L): 802.11±92.58 vs. 822.39±107.23, P < 0.05 or P < 0.01]. Conclusions In the aspect of elimination of large and medium sized molecules, the effect of combined artificial kidney is much better than that of simple HFHD. The rates of toxin elimination in different types of combined artificial kidney treatment are different, and the HFHD+HP type has greater effect than HP+HFHD type on elimination of toxins with large or medium sized molecules such as iPTH, FGF-23, etc.