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Phosphate Removal During Conventional Hemodialysis: a Decades-Old Misconception
Rosilene M Elias1, Valeria R C Alvares1, Rosa M A Moysés1,2
1Department of Medicine, Renal Division, Universidade de São Paulo, São Paulo, Brazil.
Kidney & Blood Pressure Research
|February 8, 2018
Summary
Despite serum phosphate levels normalizing within the first hour of hemodialysis, only 25% of the total phosphate removal occurs during this period. This highlights the need for extended dialysis sessions to effectively manage phosphate levels in patients undergoing hemodialysis.
Area of Science:
- Nephrology
- Clinical Chemistry
Background:
- Hyperphosphatemia is a significant risk factor for mortality in dialysis patients.
- Conventional hemodialysis (HD) has limitations in effectively removing phosphate (P).
- A common misconception is that phosphate removal primarily occurs in the initial hour of HD.
Purpose of the Study:
- To determine the percentage of phosphate removed within the first hour of hemodialysis compared to the entire procedure.
- To evaluate the efficacy of conventional hemodialysis in phosphate clearance.
Main Methods:
- Analysis of dialysate samples from 21 patients over three consecutive hemodialysis sessions.
- Collection of spent dialysate at 1-hour intervals and at the end of each session.
- Measurement of phosphate levels in pre-dialysis serum and dialysate samples.
Main Results:
- Phosphate removal in the first hour accounted for approximately 25% of the total removal during the entire hemodialysis session.
- Serum phosphate levels normalized within the first hour, despite limited removal percentage.
- Phosphate removal correlated positively with pre-dialysis serum phosphate, parathormone levels, and ultrafiltration volume.
Conclusions:
- Hemodialysis removes only 25% of total phosphate in the first hour, despite achieving normal serum concentrations.
- Phosphate removal efficacy is linked to pre-dialysis phosphate levels and ultrafiltration.
- Extended dialysis duration may be necessary for comprehensive phosphate management.
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