Abstract: FR-PO153
48-Hour Post-Dialysis Serum Phosphate Rebound in Hemodialysis Patients Consuming a Controlled, Low-Phosphorus Diet
Session Information
- Bone and Mineral Metabolism: Phosphorus, FGF23, Vascular Calcification
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Stremke, Elizabeth, Purdue University, West Lafayette, Indiana, United States
- Trevino, Laurie, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Doshi, Simit, Indiana University, Indianapolis, Indiana, United States
- Moorthi, Ranjani N., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Hill Gallant, Kathleen M., Purdue University, West Lafayette, Indiana, United States
Background
Studies have demonstrated poor phosphorus (P) control with thrice weekly hemodialysis (HD). However, these studies did not control for dietary P intake, nor test blood frequently during the intradialytic interval. We aimed to determine serum P reduction and rebound over 48h in HD patients consuming a controlled low P diet.
Methods
Serum P (mg/dL) was analyzed pre-HD and post-HD for 48h in patients (N=13) consuming a controlled diet of ~900 mg P/day taking part in a placebo arm of a clinical trial. Subjects had been off phosphate binders for 10 days. Linear regression was used to determine relationships between the decline in serum P post-HD (post-HD drop); 48h area under the curve of serum P (48h AUC); and pre-HD serum P (Pre-HD). Repeated Measures ANOVA with Dunnett’s post-hoc test was used to determine return to pre-HD serum P levels.
Results
In our controlled diet study, 5 of 13 subjects returned to >90% of their pre-HD serum P within the first 24h post-HD, and 11 of the 13 subjects by 48h after the completion of HD. Pre-HD serum P is positively associated with 48-hr AUC (P<0.001). We found an expected correlation (r= 0.58; P= 0.04) between post-HD drop in serum P and 48h AUC of serum P post-HD. All serum P measures in the 48h post-HD period were statistically different than pre-HD serum P (p<0.0001) until 48h post-HD (p=0.15).
Conclusion
Adhering to a low P diet, even in the absence of P binders, may benefit patients receiving HD by delaying post-HD serum P rebound. Delaying the return of serum P values to pre-HD levels to between 24h and 48h post-HD may lessen overall P exposure and may translate into achieving long-term target serum P values in HD patients.
Funding
- NIDDK Support – Chugai Pharmaceutical Co., Ltd.