Int Urol Nephrol (2017) 49:1653–1659
NEPHROLOGY - ORIGINAL PAPER
Hemodialysis is associated with higher serum FGF23 level
when compared with peritoneal dialysis
· Yaoxian Liang
· Litao Cheng
· Yue Wang
· Tao Wang
· Aihua Zhang
Received: 31 January 2017 / Accepted: 21 April 2017 / Published online: 28 April 2017
© Springer Science+Business Media Dordrecht 2017
Keywords FGF23 · Hemodialysis · Peritoneal dialysis
Many prospective studies found elevated ﬁbroblast growth
factor-23 (FGF23) to independently associate with cardio-
vascular disease (CVD) and mortality in dialysis patients,
kidney transplant recipients, chronic kidney disease (CKD)
stage 2–4 and individuals with a history of coronary artery
disease [1–4]. Furthermore, when directly compared with
phosphorous and parathyroid hormone (PTH), FGF23 was
the strongest predictor of adverse outcomes [3, 4]. These
data highlight the potential of FGF23 as a sensitive bio-
marker to help clinicians more effectively discriminate risk
of related adverse outcomes.
Before FGF23 can transition from research tool to bio-
marker for use in mainstream management of patients with
end-stage renal disease (ESRD), determinants of its marked
interindividual variation in ESRD must be characterized.
FGF23 levels in this setting are often the highest encoun-
tered in clinical practice, and levels can range from 10- to
1000-fold above the normal range [1, 2, 5]. Hemodialysis
(HD) has the characteristic with intermittent dialysis, while
continuous ambulatory peritoneal dialysis (CAPD) is a sta-
ble, continuous dialysis modality with less “unphysiology”
. Treatments are more continuous. Furthermore, there is
some difference in toxin removal in these two modalities
. Therefore, different dialysis modality (peritoneal dialy-
sis and hemodialysis) may have some inﬂuence on level of
ﬁbroblast growth factor-23.
In this study, we investigate the level of FGF23 in different
dialysis modalities (peritoneal dialysis and hemodialysis) and
explore whether the differences of dialysis modalities contrib-
ute to the heterogeneity of FGF23 in dialysis population.
Background Considering the growing relevance of ﬁbro-
blast growth factor-23 (FGF23) and increased cardio-
vascular mortality in dialysis population, an analysis was
performed to assess the inﬂuence of dialysis modality (per-
itoneal dialysis and hemodialysis) on level of FGF23.
Methods A cross-sectional study was performed in 80
continuous ambulatory peritoneal dialysis (CAPD) and 65
hemodialysis (HD) patients without residual renal function.
Levels of calcium, phosphate, parathyroid hormone and
FGF23 were measured, and their correlations were ana-
lyzed. Data on demographics, dialysis modality and FGF23
level were also analyzed.
Results A signiﬁcant correlation was found between
FGF23 and serum calcium, serum phosphate and dialysis
vintage in dialysis patients. Level of FGF23 was signiﬁ-
cantly higher in hemodialysis patients than that in perito-
neal dialysis population. Multivariable regression revealed
that, compared to CAPD, hemodialysis was found to be a
predictor for higher FGF23 level, which was independent
of serum calcium and phosphate level (P < 0.05).
Conclusions These ﬁndings demonstrate that FGF23 levels
are signiﬁcantly higher in hemodialysis patients than that
in peritoneal dialysis patients. We demonstrate an impor-
tant association between dialysis modality (HD vs CAPD)
and higher FGF23, independent of classical determinants
(serum calcium and phosphate level).
* Shuhong Bi
Division of Nephrology, Peking University Third Hospital,
49 North Garden Rd, Haidian District, Beijing 100191,
People’s Republic of China