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. 2022 Jul-Aug;36(4):1769-1776.
doi: 10.21873/invivo.12890.

Efficacy of Supra-HFR in Removing FGF23 and Cytokines: A Single Session Analysis

Gabriele Donati  1 , Andrea Angeletti  2 , Maria Cappuccilli  2 , Chiara Donadei  2 , Chiara Guglielmo  2 , Anna Scrivo  2 , Lorenzo Gasperoni  3 , Maddalena Zambelli  2 , Maria Mattiotti  2 , Gaetano La Manna  4
Affiliations

Efficacy of Supra-HFR in Removing FGF23 and Cytokines: A Single Session Analysis

Gabriele Donati et al. In Vivo. 2022 Jul-Aug.

Abstract

Background/aim: Supra hemodiafiltration with reinfusion of the endogenous ultrafiltrate (Supra-HFR) is a dialysis technique used to improve uremic toxin removal in the range of the middle molecular weight molecules. Supra-HFR does not require the preparation and online infusion of high-purity dialysis water because it allows the production of an endogenous ultrafiltrate that undergoes detoxification through an adsorbing resin.

Patients and methods: We investigated the ability of Supra-HFR to remove fibroblast growth factor 23 (FGF23), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), interleukin 8 (IL-8), and transforming growth factor alpha (TGF-alpha) after a single session dialysis in nine patients affected by end stage renal disease (ESRD). The same patients underwent a single session of online hemodiafiltration (OL-HDF) to evaluate possible differences in FGF23 and IL-6 levels.

Results: A significant reduction in FGF23 was observed with both Supra-HFR (p=0.001) and OL-HDF. As for TNF-alpha and TGF-alpha, which were measured using Supra-HFR only, their percentage values were significantly lower at the end of dialysis than at the start (p=0.0028 and p=0.03, respectively). This did not change with post-dialysis rebound. Supra-HFR was found to have no effect on IL-6 and IL-8. Interestingly, the removal rate for FGF23 and IL-6 was similar to that observed with OL-HDF.

Conclusion: Supra-HFR was not superior to OL-HDF, with suboptimal convective volume in the removal of the molecules tested, especially FGF23, which is considered a large middle molecular weight uremic toxin.

Keywords: FGF23; IL-6; IL-8; Supra hemodiafiltration; TGF-alpha; TNF-alpha; online hemodiafiltration.

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Conflict of interest statement

The Authors declare no conflicts of interest in relation to this study.

Figures

Figure 1
Figure 1. Supra hemodiafiltration with reinfusion of the endogenous ultrafiltrate scheme. Δ body weight: the intradialytic weight loss; kDa: kilodaltons; Qb: blood flow rate; Qdin: dialysate inflow: SC: sieving coefficient; Qdout: dialysate outflow; Qplw: plasma water flow rate; QR: plasma water reinfusion rate; M.W.: molecular weight.
Figure 2
Figure 2. FGF23 (A) and IL-6 (B) trends at the three experimental time points in Supra-HFR and OL-HDF. Values are expressed as median with interquartile range of 9 treatments for both techniques. Significance is reported for T1 vs. T0: p=0.001 for Supra-HFR and p=0.04 for OLHDF. No significant differences are reported between the two techniques. All the comparisons were analyzed by Mann-Whitney nonparametric test. HFR: Hemodiafiltration with reinfusion of the endogenous ultrafiltrate; OL-HDF: online hemodiafiltration.
Figure 3
Figure 3. TNF-alpha (A), IL-8 (B) and TGF-alpha (C) trends at the three experimental time points. Values are expressed as median with interquartile range and represent 9 treatments with Supra-HFR. HFR: Hemodiafiltration with reinfusion of the endogenous ultrafiltrate.
See this image and copyright information in PMC

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