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Optimal Control of Phosphatemia by Short Daily Hemodialysis
Author(s) -
Galland R.,
Traeger J.,
Delawari E.,
Arkouche W
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01215.x
Subject(s) - sdhd , hyperphosphatemia , medicine , hemodialysis , phosphorus , phosphate , secondary hyperparathyroidism , endocrinology , biochemistry , biology , chemistry , calcium , parathyroid hormone , organic chemistry , germline mutation , gene , mutation
Hyperphosphatemia is a major risk factor in maintenance of hemodialysis patients, not only in the pathogenesis of secondary hyperparathyroidism but also in the progressive calcic vascular disease. Phosphorus is present in all nutrients rich in proteins and we can’t remove completely phosphorus intake by diet restriction or phosphate binders. Better nutritional status with higher protein intake appears with short daily hemodialysis (SDHD). Does SDHD allow a better phosphorus elimination than SHD? Ten patients mean age 52.3 ± 6.4 yrs treated on standard hemodialysis (SHD) from 11.2 ± 4.3 yrs 4 to 5 h × 3/week were switched to SDHD 2 to 2.5 h × 6/week. We have compared in the same patient phosphatemia (P), weekly phosphates removal (WPR), daily phosphates intake (DPI), and phosphates binders in SHD and in SDHD at the third month (SDHD1) and at long term (SDHD2). Results were expressed as mean ± SD and statistical analysis between SHD and SDHD were studied using Students paired t‐test.SHD SDHD1 SDHD2P (mmol/l) 2.3 ± 0.7 1.9 ± 0.5** 1.8 ± 0.4** WPR (mmol) 99.8 ± 20.8 113.5 ± 25.8* 128.2 ± 45.8* DPI (mg) 968 ± 192 1149 ± 223** 1535 ± 701* P binders +++ ++ ++* p < 0.05 ** p < 0.001P was significantly lower in SDHD despite a reduction in phosphates binders and high phosphates intake with better nutritional status as seen usually with SDHD. There were no significant differences between either P and DPI in the two periods on SDHD. We have confirmed these results by kinetics studies showing that 60% of phosphate elimination take place mainly during the first 2 h of dialysis sessions; so the overall WPR is higher with SDHD. We conclude that increased sessions frequency increases phosphates elimination and decreases the risk of hyperphosphatemia.