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Abstract: TH-PO306

Impact of Residual Renal Function (RRF) on Phosphate Clearance (PhCl) in Peritoneal Dialysis (PD)

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Anam, Smitha Reddy, Jerry L Pettis VA Medical Center, Loma Linda, California, United States
  • Fung, Enrica, Jerry L Pettis VA Medical Center, Loma Linda, California, United States
  • Sadjadi, Seyed-ali, Jerry L Pettis VA Medical Center, Loma Linda, California, United States
Background

Hyperphosphatemia is common in ESRD & is independently associated with increased risk of death among dialysis patients. In PD, the relationship between PhCl & D/P Cr or D/P PO4 is not well established.There is a suggestion that Low(L)&Low Average(LA) transporters have better PhCl with CAPD than APD. Our aim is to study the effects of RRF on PhCl in patients on APD and if its loss is compensated by adjusting dialysis dose.

Methods

55 patients on APD were retrospectively reviewed. 30 patients qualified for the study.15 had loss of RRF(Group 1),defined as UOP ≦ 200 cc/24 hr &15 who did not lose RRF(Group 2). PhCl was calculated from the combined 24hr collection of peritoneal effluent and urine.

Results

Patients in both groups were all male & on APD. Most common etiology for ESRD in both groups was diabetes (60%).
Group 1 cohort had an average age of 65.2±12.2, body weight 80 kg±18.7 & BMI 26.5 ±5.2. Prevalence of hyperphosphatemia
(> 5.5mg/dl) was 53% at the initiation of PD & 60% at loss of RRF with an average follow up of 36 months. PhCl dropped from 61.4L/wk to 41.9L/wk with loss of RRF(Table 1).
Group 2 cohort had an average age of 61.7±10.62, body weight 91.33±14.3 & BMI 28.45 ±4.0. Hyperphosphatemia prevalence was 40% at the beginning of PD and 60% at the end of the study period of 36 months while PhCl decreased from 96.5L/wk to 68.5L/wk.
In both groups D/P PO4 and D/P Cr remained low throughout the study. Weekly Kt/V decreased significantly but remained adequate for PD treatment (Table 1).There was stronger correlation between PhCl & D/P PO4 than with D/P Cr(R=0.53 vs 0.36), although in multivariate analysis the relationship between D/P PO4 and PhCl was not statistically significant (P=0.6)

Conclusion

Overall prevalence of hyperphosphatemia was no different in the two groups. PhCl correlated better with D/P PO4 than with D/P Cr as in prior studies. Since the numbers in our study are small, effect of transporter status on PhCl was not analyzed.These results need validation in a larger prospective study.

Table 1
 Group 1Group 2InterGroup
BaselineEnd of StudyP-ValueBaselineEnd of StudyP-ValueP-value
Hyperphosphatemia(%)53600.1140600.990.50
Total PhCl(L/wk)61.441.90.0496.568.50.020.003
D/P Cr0.460.410.390.460.450.780.63
D/P PO40.290.370.300.260.330.060.54
Renal Kt/V1.030.140.00091.560.780.0013< 0.001
Total Kt/V3.471.940.054.462.940.0060.016