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Abstract: TH-PO154

Rise in Serum Phosphate Levels Over the Past Decade Among US Hemodialysis Patients: Global Results From the DOPPS Practice Monitor

Session Information

  • CKD-MBD: Targets and Outcomes
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Guedes, Murilo Henrique, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Vega, Almudena, La Fundacion para la Investigacion Biomedica del Hospital Gregorio Maranon, Madrid, Comunidad de Madrid, Spain
  • Dasgupta, Indranil, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Hartman, John, Visonex, Green Bay, Wisconsin, United States
  • Nitta, Kosaku, Tokyo Women’s Medical University, Dept of Medicine, Tokyo, Japan
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

KDIGO Guidelines (2009 and 2017) recommended lowering phosphate levels (PO) toward the normal range among dialysis patients. We describe trends over two decades in serum phosphate levels among in-center hemodialysis (ICHD) patients in the US, Japan, and 7 European countries


The Dialysis Outcomes and Practice Patterns Study (DOPPS) is prospective study of ICHD patients. A national sample is constructed in each country by stratified random sampling of dialysis centers, refreshed at 3-year intervals. This analysis includes annual mean serum phosphate levels from DOPPS 2-7 (2002-2021).


In 2002, mean PO was 5.5 (Europe), 5.6 (Japan), and 5.7 (US) mg/dL. Levels declined in each region from 2002 to 2012 (-0.6 Europe, -0.4 Japan, -0.7 US). Since then, levels rose in US (to mean 5.6, 2021), were stable in Japan (5.3), and declined in Europe (4.8). In 2021, 52% (US), 27% (Europe), and 39% (Japan) had PO >5.5 mg/dL. In the US, overall phosphate binder PB use was stable (84-80% over 2015-2021), and PTH levels rose only modestly.


Among ICHD patients, phosphate trends over the past decade differ in the US (rising) than Japan (stable) and Europe (lower). The US trend contrasts with KDIGO recommendations and may reflect PB titration to higher targets along with more permissive dietary counseling. Hemodiafiltration use (none in US, common elsewhere) may also contribute. Optimal phosphate targets have yet to be ascertained by clinical trials, and effects on patient outcomes are uncertain.

Figure. Serum phosphate trends among ICHD patients, from 2002 to 2021.
[DOPPS phases 2-7 included facilities from the US, Japan, and 7 European countries (Belgium, France, Germany, Italy, Spain, Sweden, United Kingdom). The period covers 123.997 patient-months from the US, 23.789 from Japan and 34.208 from Europe.]


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