Phosphate enrichment of dialysate for use in standard and extended haemodialysis.
OBJECTIVE
Intensive haemodialysis (HD) sometimes causes hypophosphataemia, but phosphate-containing dialysate is not readily available. We examined the effectiveness of extemporaneously producing a phosphate-rich dialysate for use in HD.


METHODS
Incremental volumes of Fleet® were added to acid concentrate and predicted to deliver dialysate phosphate concentrations of 0.19-1.1 mmol/l, following mixture with ultrapure water and base concentrate by the HD machine.


RESULTS
The achieved concentrations were close to predicted values (p = 0.77) and remained stable throughout an 8-hour 'treatment' time (p = 0.99). The dialysate phosphate concentration had a linear relationship with the Fleet® volume added, defined by the regression equation y = 172.79 x - 1.47 (R(2) = 0.99, r = 0.99, p = 0.003). The dialysate pH, calcium, magnesium and bicarbonate concentrations did not change over the study period (p = 0.28-0.99). Microscopic analysis under polarised light showed no evidence of crystal formation.


CONCLUSIONS
The study validates a simple, reliable and cost-effective protocol for phosphate supplementation in conventional and extended HD.
Department of Renal Medicine, Manchester Royal Infirmary, Manchester, UK. leonard.ebah@doctors.org.uk
Leonard M
LM
Ebah
Mehvosh
M
Akhtar
Ian
I
Wilde
Graeme
G
Hookway
Mark
M
Vincent
Christopher
C
Reeves
John
J
Denton
John
J
Woods
Sandip
S
Mitra
D001639:Bicarbonates / Q000737:chemistry; D002118:Calcium / Q000737:chemistry; D015312:Hemodialysis Solutions / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008274:Magnesium / Q000737:chemistry; D010710:Phosphates / Q000737:chemistry*; D006435:Renal Dialysis / Q000009:adverse effects
D001639:Bicarbonates; D015312:Hemodialysis Solutions; D010710:Phosphates; D008274:Magnesium; D002118:Calcium