TY  - JOUR
A1  - Schneider, Andreas
A1  - Schneider, Markus P.
A1  - Krieter, Detlef H.
A1  - Genser, Bernd
A1  - Scharnagl, Hubert
A1  - Stojakovic, Tatjana
A1  - Wanner, Christoph
A1  - Drechsler, Christiane
T1  - Effect of high-flux dialysis on circulating FGF-23 levels in end-stage renal disease patients: results from a randomized trial
JF  - PLoS ONE
N2  - Background 
In patients undergoing maintenance hemodialysis (HD), increased levels of circulating fibroblast growth factor-23 (FGF-23) are independently associated with cardiovascular events and mortality. Interventional strategies aiming to reduce levels of FGF-23 in HD patients are of particular interest. The purpose of the current study was to compare the impact of high-flux versus low-flux HD on circulating FGF-23 levels. 

Methods 
We conducted a post-hoc analysis of the MINOXIS study, including 127 dialysis patients randomized to low-flux (n = 62) and high-flux (n = 65) HD for 52 weeks. Patients with valid measures for FGF-23 investigated baseline and after 52 weeks were included. 

Results 
Compared to baseline, a significant increase in FGF-23 levels after one year of low-flux HD was observed (Delta plasma FGF-23: +4026 RU/ml; p < 0.001). In contrast, FGF-23 levels remained stable in the high flux group (Delta plasma FGF-23: +373 RU/ml, p = 0.70). The adjusted difference of the absolute change in FGF-23 levels between the two treatment groups was statistically significant (p < 0.01). 

Conclusions 
Over a period of 12 months, high-flux HD was associated with stable FGF-23 levels, whereas the low-flux HD group showed an increase of FGF-23. However, the implications of the different FGF 23 time-trends in patients on high flux dialysis, as compared to the control group, remain to be explored in specifically designed clinical trials.
KW  - chronic kidney disease
KW  - left ventricular hypertrophy
KW  - phosphate homeostasis
KW  - hemodialysis
KW  - mortality
KW  - fibroblast growth factor-23
KW  - mineral metabolism
KW  - parathyroid hormone
KW  - cardiovascular events
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148559
VL  - 10
IS  - 5
ER  - 
TY  - JOUR
A1  - Drechsler, Christiane
A1  - Ritz, Eberhard
A1  - Tomaschitz, Andreas
A1  - Pilz, Stefan
A1  - Schönfeld, Stephan
A1  - Blouin, Katja
A1  - Bidlingmaier, Martin
A1  - Hammer, Fabian
A1  - Krane, Vera
A1  - März, Winfried
A1  - Allolio, Bruno
A1  - Fassnacht, Martin
A1  - Wanner, Christoph
T1  - Aldosterone and cortisol affect the risk of sudden cardiac death in haemodialysis patients
JF  - European Heart Journal
N2  - Background: Sudden cardiac death is common and accounts largely for the excess mortality of patients on maintenance dialysis. It is unknown whether aldosterone and cortisol increase the incidence of sudden cardiac death in dialysis patients.

Methods and results: We analysed data from 1255 diabetic haemodialysis patients participating in the German Diabetes and Dialysis Study (4D Study). Categories of aldosterone and cortisol were determined at baseline and patients were followed for a median of 4 years. By Cox regression analyses, hazard ratios (HRs) were determined for the effect of aldosterone, cortisol, and their combination on sudden death and other adjudicated cardiovascular outcomes. The mean age of the patients was 66 ± 8 years (54% male). Median aldosterone was <15 pg/mL (detection limit) and cortisol 16.8 µg/dL. Patients with aldosterone levels >200 pg/mL had a significantly higher risk of sudden death (HR: 1.69; 95% CI: 1.06–2.69) compared with those with an aldosterone <15 pg/mL. The combined presence of high aldosterone (>200 pg/mL) and high cortisol (>21.1 µg/dL) levels increased the risk of sudden death in striking contrast to patients with low aldosterone (<15 pg/mL) and low cortisol (<13.2 µg/dL) levels (HR: 2.86, 95% CI: 1.32–6.21). Furthermore, all-cause mortality was significantly increased in the patients with high levels of both hormones (HR: 1.62, 95% CI: 1.01–2.62).

Conclusions: The joint presence of high aldosterone and high cortisol levels is strongly associated with sudden cardiac death as well as all-cause mortality in haemodialysed type 2 diabetic patients. Whether a blockade of the mineralocorticoid receptor decreases the risk of sudden death in these patients must be examined in future trials.
KW  - mortality
KW  - kidney disease
KW  - cardiovascular events
KW  - sudden cardiac death
KW  - cortisol
KW  - aldosterone
Y1  - 2013
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-132562
VL  - 34
ER  -