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Perit Dial Int 29(4): 465-471
2009
© 2009 International Society for Peritoneal Dialysis
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Clinical

DIALYTIC PHOSPHATE REMOVAL: A MODIFIABLE MEASURE OF DIALYSIS EFFICACY IN AUTOMATED PERITONEAL DIALYSIS

Claus P. Schmitt1,a, Dagmara Borzych1,2,a, Barbara Nau1, Elke Wühl1, Aleksandra Zurowska2 and Franz Schaefer1

Division of Pediatric Nephrology,1 Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany; Department of Pediatric Nephrology,2 Medical University of Gdansk, Poland

a These authors contributed equally to this study.

Correspondence to: F. Schaefer, Division of Pediatric Nephrology, University Children's Hospital, Im Neuenheimer Feld 151, 69120 Heidelberg, Germany. franz.schaefer{at}med.uni-heidelberg.de

{diamondsuit} 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.

{diamondsuit} Methods and Patients: 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.

{diamondsuit} 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 R2 = 0.48, p < 0.001), the number of cycles (r = 0.52, p < 0.001), 2-hour D/P phosphate (partial R2 = 0.07, p = 0.001), dwell time (partial R2 = 0.05, p = 0.01), and achieved ultrafiltration (partial R2 = 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 m2/day, p < 0.05), whereas creatinine equilibration and clearance rates were not distinctive.

{diamondsuit} Conclusion: 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.

KEY WORDS: Phosphate clearance; peritoneal transport; adequacy; children.

Received 5 May 2008; accepted 12 September 2008.






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