Phosphorus balance and mineral metabolism with 3h daily hemodialysis

• Published in: Kidney international Vol. 71; no. 4; pp. 336 - 342
• Main Authors: Ayus, J.C., Achinger, S.G., Mizani, M.R., Chertow, G.M., Furmaga, W., Lee, S., Rodriguez, F.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 02.02.2007; Nature Publishing
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; daily dialysis; Emergency and intensive care: renal failure. Dialysis management; hyperphosphatemia; Intensive care medicine; Medical sciences; mineral metabolism; Nephrology. Urinary tract diseases; quotidian dialysis; secondary hyperparathyroidism; short daily hemodialysis; daily dialysis; secondary hyperparathyroidism; mineral metabolism; short daily hemodialysis; quotidian dialysis; hyperphosphatemia; Endocrinopathy; Hydroelectrolytic balance disorder; Secondary; Nephrology; Hemodialysis; Phosphorus; Minerals; Metabolism; Inorganic element; Urology; Extrarenal dialysis; Metabolic disorder; Daily; Parathyroid diseases; Hyperphosphatemia; Dialysis; Balance; Hyperparathyroidism
• DOI: 10.1038/sj.ki.5002044
• ISSN: 0085-2538

Poor control of mineral metabolism is independently associated with mortality in patients receiving hemodialysis. We analyzed data from a 12-month, prospective, non-randomized, controlled study of daily hemodialysis (DHD) (six sessions/week 3h each) (n=26) vs conventional hemodialysis (CHD) (three sessions/week 4h each) (n=51) for achievement of mineral metabolism goals and we performed a substudy of weekly dialytic phosphorus removal in DHD vs CHD. Phosphorus control was superior in the DHD group (% change from baseline to end-of-study -27±30% vs+7%±35% in the CHD group, P=0.0001). Percentage of patients using phosphate binders decreased from 77 to 40% among subjects on DHD, whereas these parameters did not change (76 vs 77%) in the CHD group (P=0.03 by Breslow–Day test for homogeneity of the odds ratios). Weekly mean phosphorus removal was higher in the DHD group (2452±720mg/week vs 1572±366mg/week, P=0.04). Mean normalized protein catabolic rate increased (0.90±0.43–1.22±0.26g/kg/day, P=0.0013). DHD was also associated with an increase in the percent of subjects achieving three or more mineral metabolism goals (for phosphorus, calcium × phosphorus and parathyroid hormone) (15 vs 46%, P=0.046). In conclusion, DHD improves phosphorus control by increasing dialytic phosphorus removal while maintaining nutritional status and reducing the use of phosphate binders. The net effect allows for improved achievement of mineral metabolism goals.