SP287
SERUM FIBROBLAST GROWTH FACTOR-23 (FGF-23), SOLUBLE KLOTHO (SKLOTHO) AND SCLEROSTIN LEVELS AS MARKERS OF CARDIOVASCULAR COMPLICATIONS IN RUSSIAN PATIENTS WITH END STAGE OF RENAL DISEASE (REGULAR HEMODIALYSIS AND HEMODIAFILTRATION ON LINE)

INTRODUCTION AND AIMS: Cardiovascular complications (CVC) are the main cause of death in chronic kidney disease (CKD) patients. CVC markers are actively studied now for cardio-renoprotective strategy optimization in CKD, including its end stages. We have conducted a cross-sectional study to explore the clinical importance of FGF-23, sKlotho, sclerostin levels changes for in aspect of cardiovascular risk in patients with end stage of renal disease (ESRD) receiving treatment with regular hemodialysis (HD) or hemodiafiltration (HDF) on-line.

METHODS: 42 patients with CKD 5D st.at the age of 18-25 years, treated with HD or HDF on line for at least 6 months were examined. 22 (52.3%) patients received traditional HD treatment, 20 (47.7%) - by HDF on line. In all the patients, in addition to a general examination, the serum levels of FGF-23 (Human FGF-23 ELISA), using monoclonal antibodies to the native human FGF-23 molecule, Merk Millipore ), sKlotho (Human soluble alpha-Klotho Assay, IBL-Takara), sclerostin (Human Sclerostin ELISA, Biomedica), troponin I (high-sensitive human cTnI ELISA assay) were studied. Instrumental methods were: electrocardiography, echocardiography (left ventricular myocardium mass index (LVMI), left ventricle diastolic dysfunction (LVDD) as well as and sphygmography (central (aortic) arterial blood pressure (CBP), blood supply of the subendocardium (SBS) by «Sphygmocor» devise. In addition,as well as the effects of regular HD and HDF on serum levels of the studied markers, were assessed. All the patients signed informed research consent.

RESULTS: According to the multifactorial analysis, from all the studied markers, increased FGF-23 levels had an independent effect both on the risk of LVH (eccentric type) [beta = 2.436, p<0.001] and subincreasing of troponin I in serum [beta =4.613, p <0.01] Decreased sKlotho level was the factor most associated with the increased CBP (CBP>130/90 mm Hg) [beta =-0.037 p<0.01] as well as LVH (concentric type) [beta=-0.052, p<0.01]. The increased levels of sclerostin were correlated with a lower incidence of reduced SBS [ r=0.467 p<0.05], symptoms of coronary heart disease [r=-0.498 p<0.01], LVDD [r=-0.524 p<0.05] and rhythm disturbances [r=-0.512 p<0.01]. In patients with HD, higher FGF-23 and lower sKlotho and sclerostin serum levels were associated with: inadequate dialysis syndrome (Kt/V<1,1), chronic inflammation (C-reactive protein>10 mg/L), and with a decreased serum albumin level (<35 g/l). The abnormalities of FGF-23/sKlotho/sclerostin was more pronounced in patients treated with HD [p<0.05] then HDF. In addition, a direct correlation [r =0.353, p<0.01) was established between serum FGF-23 and phosphorus levels, which was more pronounced in HD patients [p<0.05].

CONCLUSIONS: In the regular HD or HDF patients higher FGF-23 and lower serum sKlotho and sclerostin levels were are associated with chronic inflammation, malnutrition, secondary hyperparathyroidism and may considered as markers predictors of a high risk of the cardiovascular complications (LVH, rhythm disturbances, persisting of sub increased serum levels of troponin I).