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The Phosphorus Cycle01:21

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Unlike carbon, water, and nitrogen, phosphorus is not present in the atmosphere as a gas. Instead, most phosphorus in the ecosystem exists as compounds, such as phosphate ions (PO43-), found in soil, water, sediment and rocks. Phosphorus is often a limiting nutrient (i.e., in short supply). Consequently, phosphorus is added to most agricultural fertilizers, which can cause environmental problems related to runoff in aquatic ecosystems.
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Measuring Phosphorus Release in Laboratory Microcosms for Water Quality Assessment
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Modification and Validation of the Phosphate Removal Model: A Multicenter Study.

Weichen Zhang1, Qiuna Du2, Jing Xiao3

  • 1Nephrology, Huashan Hospital, Fudan University, Shanghai, China.

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|January 21, 2021
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Summary

A new model accurately estimates phosphate removal during hemodialysis (HD) and hemodiafiltration (HDF) treatments. This tool aids in managing phosphate balance and hyperphosphatemia therapy.

Keywords:
HemodialysisHyperphosphatemiaModel modificationPhosphate removal

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Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Biomedical Engineering

Background:

  • Previous noninvasive model estimated phosphate removal in 4-hour hemodialysis (HD).
  • Need to modify and validate a new model for both HD and hemodiafiltration (HDF).

Purpose of the Study:

  • To modify and validate an improved noninvasive model for estimating phosphate removal.
  • To assess the model's accuracy in both HD and HDF treatments.

Main Methods:

  • 109 HD patients from 3 centers were enrolled.
  • Phosphate removal calculated using area under the dialysate phosphate concentration curve.
  • Second-order multivariable polynomial regression used for model modification, incorporating dialyzer phosphate clearance.

Main Results:

  • Phosphate removal was comparable between 4-h HD (19.06 ± 8.12 mmol) and HDF (17.38 ± 6.75 mmol).
  • The modified model formula: Tpo4 = 80.3 × C45 - 0.024 × age + 0.07 × weight + β × clearance - 8.14.
  • Internal and external validation showed the new model superior to the original, with smaller bias and higher accuracy.

Conclusions:

  • A new, validated model quantifies phosphate removal in 4-h HD and HDF (dialyzer surface area 1.3-1.8 m²).
  • This model supports phosphate balance evaluation and personalized hyperphosphatemia treatment.