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Peritoneal phosphate removal varies by peritoneal dialysis regimen: an underestimated parameter of phosphate control.
MedLine Citation:
PMID:  22460184     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: The optimization of phosphate (P) removal by peritoneal dialysis (PD) is often underestimated. Our objective was to investigate peritoneal P clearance and its relationship with standard adequacy targets, hyperphosphatemia and automated PD (APD) parameters. Methods: Dialysis dose, P clearances (24-hour urine and effluent samples), estimated percentage of diffusive P removal and peritoneal transport rate (PET) were evaluated in 77 adult prevalent PD patients. Results: Total P removal strongly correlated with residual renal function parameters, dissociated from peritoneal Kt/V urea (r=-0.36; p=0.02) and creatinine clearance (r=-0.32; p and lt;0.0001). A correlation of P clearance with net ultrafiltration was not found. Among the variables studied, only renal and peritoneal P clearances were significantly lower in hyperphosphatemic patients. In APD, peritoneal phosphate clearance was positively correlated with 4-hour dialysate to plasma creatinine ratio (r=0.46; p=0.039). Slow transporters had higher peritoneal P clearances under continuous ambulatory PD (CAPD) regimens. Hyperphosphatemia was significantly associated with a lower number of APD cycles and shorter nightly therapy time, with insufficient dwell time individualization. Conclusions: P peritoneal clearance is a modifiable parameter of P control in PD regimens and an additional adequacy target. Prescription skills are recommended in APD patients, particularly in anurics, to take into account peritoneal transport rate.
Authors:
Carlos Botelho; Anabela Rodrigues; Jose Carlos Oliveira; António Cabrita
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-16
Journal Detail:
Title:  Journal of nephrology     Volume:  -     ISSN:  1724-6059     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  0     Citation Subset:  -    
Affiliation:
Department of Nephrology, CHP - Santo António Hospital, Porto - Portugal; and Institute of Biomedical Sciences Abel Salazar/Multidisciplinary Unit of Biomedical Investigation (ICBAS/UMIB), University of Porto, Porto - Portugal.
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