PD396 - EARLY METABOLIC IMBALANCE FOLLOWING HEMODIALYSIS INITIATION IN INCIDENT PATIENTS

PD396

EARLY METABOLIC IMBALANCE FOLLOWING HEMODIALYSIS INITIATION IN INCIDENT PATIENTS

D. Mafra^1,*, J. S. de Brito², A. Figueiredo¹, C. E. H. Braga², A. Pereira³, K. Coutinho-Wolino², H. D. L. Corrêa⁴, T. D. S. Rosa⁵

¹Federal University Fluminense, ²Federal University of Rio de Janeiro, ³State University of Rio de Janeiro , Rio de Janeiro, ⁴Catholic University of Brasília , Brasilia, ⁵State University of Northern Paraná, Jacerezinho, Brazil

Rationale: Chronic kidney disease (CKD) is characterized by metabolic dysregulation, including alterations in hormones and signaling molecules involved in energy metabolism, oxidative stress, and cellular homeostasis, which are associated with protein-energy wasting, inflammation, and adverse clinical outcomes. The initiation of hemodialysis (HD) represents a critical metabolic transition that may exacerbate these dysregulated pathways. Therefore, this study aimed to investigate longitudinal changes in metabolic biomarkers in incident HD patients over six months.

Methods: This longitudinal study included 10 incident HD patients (mean age 54.7 ± 14.1 years; 59.2% men), assessed at the initiation of dialysis and after six months of follow-up. Circulating levels of sestrin 2, fibroblast growth factor 21 (FGF21), adiponectin, irisin, and Klotho were measured by enzyme-linked immunosorbent assay (ELISA), while protein carbonylation was determined using the Levine method.

Results: No significant changes were observed in protein carbonylation or sestrin 2 levels over the study period. However, significant reductions were found in adiponectin (34.9 ± 12.9 to 29.8 ± 13.4 µg/mL; p < 0.001) and irisin plasma levels (23.1 ± 5.2 to 20.7 ± 6.0 ng/mL, p = 0.009), along with a borderline reduction in klotho levels (604.5 ± 198.6 to 589.0 ± 197.6 pg/mL; p = 0.051). Conversely, FGF21 levels increased significantly after six months of HD (684.9 ± 266.7 to 701.8 ± 261.6 pg/mL; p = 0.001).

Conclusion: Hemodialysis initiation is associated with an early imbalance in metabolic signaling, marked by increased FGF21 and reduced levels of key regulatory hormones. This dissociation between adaptive and protective pathways highlights persistent metabolic dysfunction, underscores the complexity of early metabolic responses to dialysis, and may inform risk stratification and targeted interventions.

Disclosure of Interest: None declared