Peritoneal membrane phosphate transport status: a cornerstone in phosphate handling in peritoneal dialysis.
OBJECTIVE
Phosphate control impacts dialysis outcomes. Our aim was to define peritoneal phosphate transport in peritoneal dialysis (PD) and to explore its association with hyperphosphatemia, phosphate clearance (PPhCl), and PD modality.


METHODS
Two hundred sixty-four patients (61% on continuous ambulatory PD [CAPD]) were evaluated at month 12. PPhCl was calculated from 24-hour peritoneal effluent. Phosphate (Ph) and creatinine (Cr) dialysate/plasma (D/P) were calculated at a 4-hour 3.86% peritoneal equilibration test.


RESULTS
D/PPh correlated with D/PCr. PPhCl correlated better with D/PPh than with D/PCr. Prevalence of hyperphosphatemia (>5.5 mg/dl) was 30%. In a multiple regression analysis, only residual renal function was independently, negatively associated with hyperphosphatemia; in anuric patients, only D/PPh was an independent factor predicting hyperphosphatemia. D/PPh was 0.57 ± 0.10, and according to this, 16% of the patients were fast, 31% were fast-average, 35% were slow-average, and 17% were slow transporters. PPhCl was 37.5 ± 11.7 L/wk; it was lower in the slow transporter group (31 ± 14 L/wk). Among fast and fast-average transporters, PPhCl was comparable in both PD modalities. In comparison to automated PD, CAPD was associated with increased PPhCl among slow-average (36 ± 8 versus 32 ± 7 L/wk) and slow transporters (34 ± 15 versus 24 ± 9 L/wk).


CONCLUSIONS
In hyperphosphatemic, particularly anuric, patients, optimal PD modality should consider peritoneal phosphate transport characteristics. Increasing dwell times and transfer to CAPD are effective strategies to improve phosphate handling in patients with inadequate phosphate control on automated PD.
Nephrology Department, Amato Lusitano Hospital, Castelo Branco, Portugal. anabernardo@portugalmail.pt
Ana Paula
AP
Bernardo
Sebastián Azorin
SA
Contesse
Maria Auxiliadora
MA
Bajo
Anabela
A
Rodrigues
Gloria
G
Del Peso
Marta
M
Ossorio
António
A
Cabrita
Rafael
R
Selgas
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001002:Anuria / Q000097:blood / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000378:metabolism / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000209:etiology* / Q000628:therapy; D007674:Kidney Diseases / Q000097:blood / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000295:instrumentation*; D010539:Permeability; D010710:Phosphates / Q000097:blood*; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D015314:Dialysis Solutions; D008567:Membranes, Artificial; D010710:Phosphates; D003404:Creatinine