Abstract
Abstract Background and Aims According to a survey by the Japanese Society for Dialysis Therapy (as of December 31, 2017), among the 9,090 patients that underwent peritoneal dialysis (PD) in Japan, 1,765 patients were treated with PD in combination with once-weekly hemodialysis (HD) or hemodiafiltration (HDF) (PD-HD/HDF combination therapy); these patients accounted for 19.4% of the overall PD population. It has been confirmed that middle-molecular-weight solutes, such as β2MG, α1MG, that cannot be effectively removed by PD can be removed by HD/HDF in PD-HD/HDF combination therapy. In this study, we examined the changes in CKD-MBD-related markers (phosphorus, PTH, FGF-23 [molecular weight 32,000 Da], Fetuin-A [molecular weight 59,000 Da]) and middle-molecular-weight solutes (β2MG [molecular weight 11,800 Da] and α1MG [molecular weight 32,000 Da]) in nine patients on PD-HD combination therapy. Method We recruited nine patients (four men, five women) on PD-HD combination therapy with an underlying disease of chronic glomerulonephritis. The patients had a mean age of 66.2 years and a mean dialysis period of 49.1 months on PD alone and 32.1 months on PD combined with HD. The PD protocol included 2 L bag × 4/day (5 days, Monday–Friday; no therapy on Saturday and Sunday), and the HD protocol included 4 hours QB at 200 mL/min, QD at 500 mL/min, and Dialyzer Polysulfone (Asahi Medical Japan) every Saturday. Blood was collected before and after HD and before the next HD (1 week later) to measure CKD-MBD-related markers and middle-molecular-weight solutes. Kits to measure FGF-23 (Millipore, US) and Fetuin-A (Biovendor, Czech) were used. Results The levels of the different markers and solutes were as follows: phosphorus (mg/dL) (mean before HD: 5.31, mean after HD: 2.28 (P < 0.01), and mean before the next HD: 5.53); iPTH (pg/mL) (mean before HD: 131.9, mean after HD: 98.8, and mean before the next HD: 125.9); FGF-23 (pg/mL) (mean before HD: 785.3, mean after HD: 576.1 (P < 0.01), and mean before the next HD: 897); Fetuin-A (μg/mL) (mean before HD: 427.9, mean after HD: 423.1, and mean before the next HD: 428.75); β2MG (mg/L) (mean before HD: 36.31, mean after HD: 13.23 (P < 0.01), and mean before the next HD: 36.11); and α1MG (mg/L) (mean before HD: 141.9, mean after HD: 130.4, and mean before the next HD: 114.8). Conclusion β2MG and phosphorus levels were significantly decreased when PD was combined with HD, confirming that HD was able to eliminate them. Furthermore FGF-23 (molecular weight 32,000 Da) significantly decreased after HD but α1MG (molecular weight 30,000 Da) did not, suggesting that the decrease in FGF-23 was caused by the decrease in blood phosphorus concentration.
Published Version
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