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Hyperphosphatemia is a predictor of overall and cardiovascular mortality in end stage renal disease (ESRD) patients treated with peritoneal dialysis (PD). Control of hyperphosphatemia is difficult to achieve for several reasons like poor adherence to dietary phosphate restriction, the decline of residual kidney function and low peritoneal phosphate clearance.
The purpose of this study was to identify variables associated with phosphate behavior in ESRD patients during the first two years of treatment with automated peritoneal dialysis (APD) therapy.
In this cross-sectional retrospective study, 73 APD patients were reviewed. Measurements of phosphate, residual kidney function and long day dwell were associated using univariate linear regressions. Pearson correlation coefficient were also analyzed at different time points. SAS University Edition version 9.4 (SAS Institute, Cary, NC) software was used for the analysis.
During the course of two years, the highest mean phosphate level was 5.87 +/- 1.66 mg/dl. In the univariate linear regressions, for each 1 ml decrease in urine output, an increase in phosphate level from 0.0001 (-0.009 - 0.0001) to 0.0006 (-0.0014 - 0.0001) was observed (Figure A). On the other hand, for each ml increase in the long day dwell, phosphate levels decreased from 0.0001 (-0.0003 - 0.0007) to 0.0005 (-0.0012 - 0.0001) (Figure B).
Residual kidney function is a crucial factor in determining phosphate behavior in PD patients. While it is widely recognized that controlling phosphate levels poses a challenge in PD patients, it is important to also take into account additional factors such as peritoneal transport, peritoneal phosphate clearance, and mineral and bone disorder. These factors will be thoroughly examined in upcoming trials to gain a comprehensive understanding of their impact.