Dialysis modality and membrane permeability modulation of FGF23 and cardiovascular calcification in ESRD

Objectives. To investigate the impact of hemodialysis modality on fibroblast growth factor-23 (FGF23) control and its association with cardiovascular calcification in end-stage renal disease (ESRD). Materials and methods. This cross-sectional study included 50 adults with ESRD on maintenance hemodialysis, separated into two groups: 25 receiving high-flux hemodialysis and 25 receiving online hemodiafiltration (HDF). FGF23 was measured pre- and post-session, and cardiovascular calcification was assessed by echocardiography (semi-quantitative cardiac/aortic root score), carotid intima–media thickness (IMT), and carotid duplex. Outcomes. Compared with high-flux hemodialysis, HDF showed significantly lower post-dialysis FGF23 levels and a higher FGF23 reduction ratio. Between groups, echocardiography and carotid duplex scores did not differ significantly; however, carotid IMT was significantly higher in the hemodialysis group. In the HDF group, post-dialysis FGF23 correlated positively with IMT. Conclusion. Online HDF was associated with a greater reduction in FGF23 and with lower carotid IMT, suggesting potential cardiovascular benefits in ESRD.