Frequent Hemodialysis Improves Serum Phosphate, Left Ventricular Mass

SAN DIEGO—Hemodialysis (HD) 6 vs 3 times per week reduces serum phosphate and improves biomarkers of mineral metabolism and left ventricular remodeling, according to study findings presented at the American Society of Nephrology’s Kidney Week 2018.

In the Frequent Hemodialysis Network Trials, investigators randomly assigned 124 HD patients were randomly assigned to HD 3 times a week (94 short daily and 30 nocturnal) and 119 to HD 6 times a week (87 daily and 32 nocturnal).

According to a post hoc analysis, more frequent HD reduced serum phosphate by a median 0.5 and 1.1 mg/dL, in the daily and nocturnal settings, respectively, Christopher T. Chan, MD, of Toronto General Hospital in Canada, and colleagues reported in a poster presentation. The fall in phosphate significantly correlated with 52% and 45% declines in fibroblast growth factor 23 (FGF23) in the daily and nocturnal trials, respectively. It also was associated with 82% and 69% decreases in systolic blood pressure, respectively.

Investigators also found evidence supporting reduced left ventricular mass (LVM). In the daily trial, changes in matrix metalloproteinase 2 correlated with lower blood pressure and LVM. In the nocturnal trial, changes in tissue inhibitors of metalloproteinase (TIMP- 1), a marker of collagen turnover, and matrix metalloproteinase 9 also correlated with reduced LVM.

“Reduction of serum phosphate by frequent hemodialysis may modulate FGF23 levels and systolic blood pressure,” Dr Chan told Renal & Urology News. “Frequent hemodialysis may affect pathological mediators of chronic kidney disease–mineral bone-metabolism disorder.” The study newly associated markers of matrix turnover with changes in left ventricular mass. “Our study findings suggest new hypotheses that warrant further research,” Dr Chan said.

Reference

Chan CT, Kaysen GA, Beck GJ, et al. The effect of frequent hemodialysis on phosphate and fibroblast growth factor 23: Results from the Frequent Hemodialysis Network Trials. Presented at the American Society of Nephrology’s Kidney Week 2018 in San Diego, Oct. 23-28. Poster TH-PO347.