The effect of dialysis modality on phosphate control : haemodialysis compared to haemodiafiltration. The Pan Thames Renal Audit

Nephrol Dial Transplant. 2010 Mar;25(3):897-901. doi: 10.1093/ndt/gfp560. Epub 2009 Oct 28.

Abstract

Background and objectives: Hyperphosphataemia is a primary risk factor for patients with end-stage kidney failure. Phosphate clearance by traditional thrice-weekly standard haemodialysis is inadequate for patients achieving recommended dietary protein goals. We investigated whether phosphate control was improved by adding convective clearance with haemodiafiltration.

Methods: We audited pre-midweek session calcium and phosphate levels in 5366 adult patients, 4515 treated by haemodialysis and 851 by on-line haemodiafiltration.

Results: The cohorts were similar for age, sex and dialysis vintage. Serum phosphate was lower in the haemodiafiltration cohort (1.42 +/- 0.61 mmol/l) compared to the haemodialysis cohort (1.53 +/- 0.53 mmol/l; P < 0.001), as was the calcium-phosphate product (3.31 +/- 1.53 vs 3.5 +/- 1.33 mmol(2)/l(2), respectively; P < 0.001) despite a shorter treatment session time (3.68 +/- 0.44 vs 3.92 +/- 0.49 h; P < 0.001). Parathyroid hormone levels were similar.

Conclusions: The results of this audit suggest that haemodiafiltration offers improved phosphate control compared to standard intermittent haemodialysis.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Calcium / blood
  • Clinical Audit*
  • Female
  • Hemodiafiltration*
  • Humans
  • Hyperphosphatemia / epidemiology
  • Kidney Failure, Chronic / blood*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Phosphates / blood*
  • Prospective Studies
  • Renal Dialysis*
  • Risk Factors
  • Treatment Outcome

Substances

  • Parathyroid Hormone
  • Phosphates
  • Calcium