Dialytic phosphate removal: a modifiable measure of dialysis efficacy in automated peritoneal dialysis.
BACKGROUND
Although hyperphosphatemia is one of the few established risk factors for cardiovascular mortality in patients on dialysis, the relationship between peritoneal dialysis (PD) prescription and dialytic phosphate removal is largely unexplored.


METHODS
We analyzed 24-hour clearances (n = 60) together with peritoneal equilibration tests (PETs) (n = 52) performed in children and adolescents (n = 35) on automated PD.


RESULTS
Dialytic phosphate clearance was more closely correlated with 2-hour and 4-hour dialysate-to-plasma ratio (D/P) of phosphate in the PETs (r = 0.44 and r = 0.52, both p < 0.0001) than with 2-hour and 4-hour D/P creatinine (r = 0.26 and r = 0.27, both p < 0.05). Dialytic 24-hour phosphate clearance was independently predicted by total fluid turnover (partial R(2) = 0.48, p < 0.001), the number of cycles (r = 0.52, p < 0.001), 2-hour D/P phosphate (partial R(2) = 0.07, p = 0.001), dwell time (partial R(2) = 0.05, p = 0.01), and achieved ultrafiltration (partial R(2) = 0.05, p = 0.005). 4-hour D/P phosphate and 24-hour phosphate clearance were significantly lower in hyperphosphatemic children (3.38 +/- 1.17 vs 4.56 +/- 1.99 L/1.73 m(2)/day, p < 0.05), whereas creatinine equilibration and clearance rates were not distinctive.


CONCLUSIONS
Dialytic phosphate removal is an important modifiable determinant of phosphate control in automated PD. It strongly depends on total dialysate turnover and the prescribed number of cycles and is more adequately predicted by phosphate than by creatinine equilibration characteristics. Due to the deleterious effects of hyperphosphatemia, dialytic phosphate removal should be monitored routinely.
Schmitt
Claus P
CP
Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany.
Borzych
Dagmara
D
Nau
Barbara
B
Wühl
Elke
E
Zurowska
Aleksandra
A
Schaefer
Franz
F
D000042:Absorption; D000293:Adolescent; D001331:Automation; D002648:Child; D002675:Child, Preschool; D015314:Dialysis Solutions / Q000009:adverse effects* / Q000493:pharmacokinetics; D005500:Follow-Up Studies; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000517:prevention & control*; D007223:Infant; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D010521:Periosteum / Q000378:metabolism*; D010530:Peritoneal Dialysis / Q000379:methods*; D010710:Phosphates / Q000378:metabolism*; D016896:Treatment Outcome
D015314:Dialysis Solutions; D010710:Phosphates