Original investigation: dialysis therapyHyperphosphatemia in Chinese peritoneal dialysis patients with and without residual kidney function: what are the implications?
Section snippets
Methods
Two hundred fifty-two patients receiving CAPD treatment for 3 months or more were recruited from our total PD patient pool of 270 at the Prince of Wales Hospital in Hong Kong. All patients were dialyzed using glucose-based lactate-buffered PD solutions. Eighteen patients were excluded based on the following exclusion criteria: namely, patients with underlying malignancy, chronic liver disease, chronic obstructive airway disease, systemic lupus erythematosus, and active tuberculous infection
Results
The frequency distribution of serum phosphorus levels of our PD patients followed a normal bell-shaped curve, with a mean of 5.2 ± 1.5 mg/dL (1.68 ± 0.47 mmol/L) and median of 5.1 mg/dL (1.64 mmol/L; lab reference range, 2.5 to 4.3 mg/dL [0.82 to 1.40 mmol/L]). Serum phosphorus levels were 5.6 mg/dL or greater (≥1.8 mmol/L) in 90 patients (35.7%), among whom 47 patients (52.2%) had serum phosphorus levels greater than 6.5 mg/dL (>2.1 mmol/L). Serum phosphorus levels were 5.6 to 6.5 mg/dL or
Discussion
To our knowledge, this is the first study that examines phosphorus control with simultaneous consideration of renal and dialysis clearance, as well as nutrition status, in Chinese CAPD patients. Previous surveys indicated that more than half the hemodialysis patients had serum phosphorus levels greater than 5.9 mg/dL (>1.9 mmol/L).1, 18 Although continuous PD is taken to be better in controlling hyperphosphatemia than intermittent hemodialysis,19 our current survey shows that hyperphosphatemia
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Volume Management With Peritoneal Dialysis
2022, Handbook of Dialysis TherapyEOS789, a broad-spectrum inhibitor of phosphate transport, is safe with an indication of efficacy in a phase 1b randomized crossover trial in hemodialysis patients
2021, Kidney InternationalCitation Excerpt :Although many dialysis patients are anuric, some patients, especially those on peritoneal dialysis, retain residual renal function. Wang et al. demonstrated that anuric patients undergoing peritoneal dialysis had elevated serum P levels nearly twice as often as patients with residual renal function.28 The removal of P with dialysis varies considerably and is affected by blood flow, dialysis duration, predialysis serum P, PTH level, and ultrafiltration volume.29,30
Strategies for Phosphate Control in Patients With CKD
2019, Kidney International ReportsCitation Excerpt :It occurs already in early stages of the disease. From a histologic point of view, renal osteodystrophy comprises high-turnover (osteitis fibrosa and mixed renal osteodystrophy) at later CKD stages and low-turnover bone disease (adynamic osteopathy) at early and later CKD stages.125,126 Both types may contribute to hyperphosphatemia, either by increasing bone resorption and phosphate release, or by reducing bone formation and phosphate uptake.
Peritoneal Dialysis Solutions, Prescription and Adequacy
2018, Chronic Kidney Disease, Dialysis, and Transplantation: A Companion to Brenner and Rector’s The KidneyEvaluation of a mineral metabolism protocol in peritoneal dialysis patients
2014, Journal of Renal NutritionCitation Excerpt :The United States Renal Data System Case Mix Adequacy and the Dialysis Morbidity and Mortality Wave II studies demonstrated that approximately 53% of HD (n = 6,407) patients had serum phosphorus levels above the range of 5.9 mg/dL (1.9 mmol/L).1 In a cross-sectional study (n = 252), Wang et al.2 found that the serum phosphorus levels were greater than 5.6 mg/dL (1.8 mmol/L) in more than 35.7% (n = 90) of PD patients with more than 50% (n = 47) of them having a level of 6.5 mg/dL (2.1 mmol/L) or greater. To address the issue of altered mineral metabolism in patients on peritoneal dialysis, current practice is to aim for set target ranges for serum phosphorus, calcium, and iPTH.
Supported in part by the Bristol Myers Squibb Foundation Nutrition Grant Program and the Hong Kong Health Service Research Fund.