Hyperphosphatemia correction in hemodialysis patients. A single center study and perspective analysis

Aim: hyperphosphatemia remains one of the most significant risk factor for mortality of dialysis patient. Its correction is a difficult problem: the capabilities and limitations of different methods are still subject to clarification in real-world practice. Methods: among prevalent patients gathered in a newly organized dialysis center, we assessed the baseline phosphate levels and trends of its changes over the period up to two years while applying all available phosphate lowering measures. After 5 years of follow-up, we evaluated the survival rate and significant risk factors. Results: the fraction of patients with phosphate level within target range (0.9÷1.78 mmol/l) increased from 27.1% to 60.3%. Patients were divided into four groups by phosphate levels: (1) stable patients in target range (53%); (2) within target range with a trend of decreasing -0.62±0.20 mmol/l/year (10%), (3) hyperphosphatemia with a trend of increasing 0.19±0.25 mmol/l/year (17%)and (4) hyperphosphatemia with a trend of decreasing -0.33±0.18 mmol/l/year (20%). In univariate Cox regression model (phosphatemia category) the third group had mortality relative risk RR=3.39; р=0.002, while the forth group did not show a difference from first group (reference): RR=1.24; р=0.67, 95%CI 0.47÷1.26. In multivariable model (beside phosphatemia category: RR=3.52; р=0.003 for third group) the significant factors included PTH <150 pg/ml, increasing PHT trend and age. The distribution of patient’s phosphatemia category significantly depended upon their compliance with dietary consultation (χ2=27.4; р=0.01). Conclusion: the effective measures for hyperphosphatemia correction include low-phosphate diet (with exclusion of inorganic phosphate additives), some dialysis regimen modification (prolong and/or frequent sessions, physical activity during session, acidosis correction), phosphate binders and hyperparathyroidism correction.

гиперфосфатемия, гемодиализ, выживаемость, фосфат-связывающие препараты, гиперпаратиреоз, hyperphosphatemia, hemodialysis, survival, phosphate binders, hyperparathyroidism

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