Document Detail


Peritoneal membrane phosphate transport status: a cornerstone in phosphate handling in peritoneal dialysis.
MedLine Citation:
PMID:  21115631     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Phosphate control impacts dialysis outcomes. Our aim was to define peritoneal phosphate transport in peritoneal dialysis (PD) and to explore its association with hyperphosphatemia, phosphate clearance (PPhCl), and PD modality.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Two hundred sixty-four patients (61% on continuous ambulatory PD [CAPD]) were evaluated at month 12. PPhCl was calculated from 24-hour peritoneal effluent. Phosphate (Ph) and creatinine (Cr) dialysate/plasma (D/P) were calculated at a 4-hour 3.86% peritoneal equilibration test.
RESULTS: D/PPh correlated with D/PCr. PPhCl correlated better with D/PPh than with D/PCr. Prevalence of hyperphosphatemia (>5.5 mg/dl) was 30%. In a multiple regression analysis, only residual renal function was independently, negatively associated with hyperphosphatemia; in anuric patients, only D/PPh was an independent factor predicting hyperphosphatemia. D/PPh was 0.57 ± 0.10, and according to this, 16% of the patients were fast, 31% were fast-average, 35% were slow-average, and 17% were slow transporters. PPhCl was 37.5 ± 11.7 L/wk; it was lower in the slow transporter group (31 ± 14 L/wk). Among fast and fast-average transporters, PPhCl was comparable in both PD modalities. In comparison to automated PD, CAPD was associated with increased PPhCl among slow-average (36 ± 8 versus 32 ± 7 L/wk) and slow transporters (34 ± 15 versus 24 ± 9 L/wk).
CONCLUSIONS: In hyperphosphatemic, particularly anuric, patients, optimal PD modality should consider peritoneal phosphate transport characteristics. Increasing dwell times and transfer to CAPD are effective strategies to improve phosphate handling in patients with inadequate phosphate control on automated PD.
Authors:
Ana Paula Bernardo; Sebastián Azorin Contesse; Maria Auxiliadora Bajo; Anabela Rodrigues; Gloria Del Peso; Marta Ossorio; António Cabrita; Rafael Selgas
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-29
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  6     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-17     Completed Date:  2011-06-30     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  591-7     Citation Subset:  IM    
Affiliation:
Nephrology Department, Amato Lusitano Hospital, Castelo Branco, Portugal. anabernardo@portugalmail.pt
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Anuria / blood,  therapy
Biological Markers / blood
Creatinine / blood
Cross-Sectional Studies
Dialysis Solutions / metabolism,  therapeutic use*
Female
Humans
Hyperphosphatemia / blood,  etiology*,  therapy
Kidney Diseases / blood,  therapy*
Male
Membranes, Artificial*
Middle Aged
Peritoneal Dialysis / adverse effects,  instrumentation*
Peritoneal Dialysis, Continuous Ambulatory / adverse effects,  instrumentation*
Permeability
Phosphates / blood*
Retrospective Studies
Spain
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Dialysis Solutions; 0/Membranes, Artificial; 0/Phosphates; 60-27-5/Creatinine
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