Hyperphosphatemia is an independent predictor of mortality in end-stage renal disease patients, and 40% – 50% of peritoneal dialysis (PD) patients have suboptimal control of serum phosphate. Systematically addressing this problem requires an understanding of phosphate balance on PD. The present review discusses the determinants of daily phosphate load and focuses on the factors influencing renal and peritoneal clearance of phosphate.
BlockG., Hulbert–ShearonT., LevinN., PortF.Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study.Am J Kidney Dis1998; 31: 607–17.
2.
BlockG.A., KlassenP.S., LazarusJ.M., OfsthunN., LowrieE.G., ChertowG.M.Mineral metabolism, mortality, and morbidity in maintenance hemodialysis.J Am Soc Nephrol2004; 15: 2208–18.
3.
YoungE.W., AlbertJ.M., SatayathumS., GoodkinD.A., PisoniR.L., AkibaT.Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study.Kidney Int2005; 67: 1179–87.
4.
Kalantar–ZadehK., KuwaeN., RegidorD.L., KovesdyC.P., KilpatrickR.D., ShinabergerC.S.Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients.Kidney Int2006; 70: 771–80.
5.
NoordzijM., KorevaarJ.C., BosW.J., BoeschotenE.W., DekkerF.W., BossuytP.M.Mineral metabolism and cardiovascular morbidity and mortality risk: peritoneal dialysis patients compared with haemodialysis patients.Nephrol Dial Transplant2006; 21: 2513–20.
6.
AnsellD.Serum phosphate and outcomes in PD patients.Nephrol Dial Transplant2007; 22: 667–8.
7.
MarchaisS.J., MetivierF., GuerinA.P., LondonG.M.Association of hyperphosphataemia with haemodynamic disturbances in end-stage renal disease.Nephrol Dial Transplant1999; 14: 2178–83.
8.
GalettaF., CupistiA., FranzoniF., FemiaF.R., RossiM., BarsottiG.Left ventricular function and calcium phosphate plasma levels in uraemic patients.J Intern Med2005; 258: 378–84.
9.
HayashiS.Y., BrodinL.A., AlvestrandA., LindB., StenvinkelP., Mazza do NascimentoM.Improvement of cardiac function after haemodialysis. Quantitative evaluation by colour tissue velocity imaging.Nephrol Dial Transplant2004; 19: 1497–506.
10.
AmmiratiA.L., DalboniM.A., CendorogloM., DraibeS.A., Fernandes CanzianiM.E.Coronary artery calcification, systemic inflammation markers and mineral metabolism in a peritoneal dialysis population.Nephron Clin Pract2006; 104: c33–40.
11.
StompórT., PasowiczM., SulowiczW., Dembinska–KiecA., TraczW.Trends in coronary artery calcification in peritoneal dialysis and transplant patients.Nephrol Dial Transplant2004; 19: 3205–6.
12.
RaggiP., BoulayA., Chasan–TaberS., AminN., DillonM., BurkeS.K.Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease?J Am Coll Cardiol2002; 39: 695–701.
MatsuokaM., IsekiK., TamashiroM., FujimotoN., HigaN., ToumaT.Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis.Clin Exp Nephrol2004; 8: 54–8.
15.
BlockG.A., RaggiP., BellasiA., KooiengaL., SpiegelD.M.Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients.Kidney Int2007; 71: 438–41.
16.
National Kidney Foundation.K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease.Am J Kidney Dis2003; 42(Suppl 3): S1–201.
17.
PoduvalR.D., WolgemuthC., FerrellJ., HammesM.S.Hyperphosphatemia in dialysis patients: is there a role for focused counseling?J Ren Nutr2003; 13: 219–23.
18.
RufinoM., de BonisE., Mar tinM., RebolloS., Mar tinB., MiquelR.Is it possible to control hyperphosphataemia with diet, without inducing protein malnutrition?Nephrol Dial Transplant1998; 13(Suppl 3): 65–7.
Cannata–AndíaJ.B., Fernández–MartínJ.L.The clinical impact of aluminium overload in renal failure.Nephrol Dial Transplant2002; 17: 9–12.
21.
SperschneiderH., GuntherK., MarzollI., KirchnerE., SteinG.Calcium carbonate (CaCO3) an efficient and safe phosphate binder in haemodialysis patients? A 3-year study.Nephrol Dial Transplant1993; 8: 530–4.
22.
BorràsM., MarcoM.P., FernándezE.Treatment with sevelamer decreases bicarbonate levels in peritoneal dialysis patients.Perit Dial Int2002; 22: 737–8.
23.
McIntyreC.W., PatelV., TaylorG.S., FluckR.J.A prospective study of combination therapy for hyperphosphataemia with calcium-containing phosphate binders and sevelamer in hypercalcaemic haemodialysis patients.Nephrol Dial Transplant2002; 17: 1643–8.
24.
MannsB., StevensL., MiskulinD., OwenW.F.Jr., WinkelmayerW.C., TonelliM.A systematic review of sevelamer in ESRD and an analysis of its potential economic impact in Canada and the United States.Kidney Int2004: 66: 1239–47.
25.
WeisingerJ.R., Bellorin–FontE.Magnesium and phosphorus.Lancet1998; 352: 391–6.
26.
PohlmeierR., VienkenJ.Phosphate removal and hemodialysis conditions.Kidney Int Suppl2001; 78: S190–4.
27.
MucsiI., HerczG., UldallR., OuwendykM., FrancoeurR., PierratosA.Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis.Kidney Int1998; 53: 1399–404.
28.
RamirezJ.A., EmmettM., WhiteM.G., FathiN., Santa AnaC.A., MorawskiS.G.The absorption of dietary phosphorus and calcium in hemodialysis patients.Kidney Int1986; 30: 753–9.
29.
BurkeS.K., SlatopolskyE.A., GoldbergD.I.RenaGel, a novel calcium- and aluminium-free phosphate binder, inhibits phosphate absorption in normal volunteers.Nephrol Dial Transplant1997; 12: 1640–4.
30.
SedlacekM., DimaanoF., UribarriJ.Relationship between phosphorus and creatinine clearance in peritoneal dialysis: clinical implications.Am J Kidney Dis2000; 36: 1020–4.
31.
BammensB., EvenepoelP., VerbekeK., VanrenterghemY.Time profiles of peritoneal and renal clearances of different uremic solutes in incident peritoneal dialysis patients.Am J Kidney Dis2005; 46: 512–19.
32.
EvenepoelP., BammensB., VerbekeK., VanrenterghemY.Superior dialytic clearance of β2-microglobulin and p-cresol by high-flux hemodialysis as compared to peritoneal dialysis.Kidney Int2006; 70: 794–9.
33.
BoazM., SmetanaS.Regression equation predicts dietary phosphorus intake from estimate of dietary protein intake.J Am Diet Assoc1996; 96: 1268–70.
34.
National Kidney Foundation, K/DOQI.Clinical practice guidelines for nutrition in chronic renal failure.Am J Kidney Dis2000; 35(Suppl 2): S1–140. [Erratum in: Am J Kidney Dis 2001; 38: 917]
35.
MessaP., GropuzzoM., ClevaM., BoscuttiG., MioniG., CruciattiA.Behaviour of phosphate removal with different dialysis schedules.Nephrol Dial Transplant1998; 13(Suppl 6): 43–8.
36.
PagéD.E., KnollG.A., CheungV.The relationship between residual renal function, protein catabolic rate, and phosphate and magnesium levels in peritoneal dialysis patients.Adv Perit Dial2002; 18: 189–91.
37.
WangA.Y., WooJ., SeaM.M., LawM.C., LuiS.F., LiP.K.Hyperphosphatemia in Chinese peritoneal dialysis patients with and without residual kidney function: what are the implications?Am J Kidney Dis2004; 43: 712–20.
38.
MenonM.K., NaimarkD.M., BargmanJ.M., VasS.I., OreopoulosD.G.Long-term blood pressure control in a cohort of peritoneal dialysis patients and its association with residual renal function.Nephrol Dial Transplant2001; 16: 2207–13.
39.
AtesK., NergizogluG., KevenK., SenA., KutlayS., ErtürkS.Effect of fluid and sodium removal on mortality in peritoneal dialysis patients.Kidney Int2001; 60: 767–76.
40.
WangA.Y., WangM., WooJ., LawM.C., ChowK.M., LiP.K.A novel association between residual renal function and left ventricular hypertrophy in peritoneal dialysis patients.Kidney Int2002; 62: 639–47.
41.
WangA.Y.M., WangM., WooJ., LamC.W.K., LuiS.F., LiP.K.T.Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients.J Am Soc Nephrol2004; 15: 2186–94.
42.
López–MencheroR., MiguelA., García–RamónR., Pérez– ContrerasJ., GirbésV.Importance of residual renal function in continuous ambulatory peritoneal dialysis: its influence on different parameters of renal replacement treatment.Nephron1999; 83: 219–25.
43.
SudaT., HiroshigeK., OhtaT., WatanabeY., IwamotoM., KanegaeK.The contribution of residual renal function to overall nutritional status in chronic haemodialysis patients.Nephrol Dial Transplant2000; 15: 396–401.
44.
BargmanJ.M., ThorpeK.E., ChurchillD.N., for the CANUSA Peritoneal Dialysis Study Group. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study.J Am Soc Nephrol2001; 12: 2158–62.
45.
LiP.K., ChowK.M., WongT Y., LeungC.B., SzetoC.C.Effects of an angiotensin-converting enzyme inhibitor on residual renal function in patients receiving peritoneal dialysis. A randomized, controlled study.Ann Intern Med2003; 139: 105–12.
46.
SuzukiH., KannoY., SugaharaS., OkadaH., NakamotoH.Effects of an angiotensin II receptor blocker, valsartan, on residual renal function in patients on CAPD.Am J Kidney Dis2004; 43: 1056–64.
47.
JansenM.A., HartA.A., KorevaarJ.C., DekkerF.W., BoeschotenE.W., KredietR.T., for the NECOSAD Study Group. Predictors of the rate of decline of residual renal function in incident dialysis patients.Kidney Int2002; 62: 1046–53.
48.
Rodriguez–BenotA., Martin–MaloA., Alvarez–LaraM.A., RodriguezM., AljamaP.Mild hyperphosphatemia and mortality in hemodialysis patients.Am J Kidney Dis2005; 46: 68–77.
49.
AyusJ.C., AchingerS.G., MizaniM.R., ChertowG.M., FurmagaW., LeeS.Phosphorus balance and mineral metabolism with 3 h daily hemodialysis.Kidney Int2007; 71: 336–42.
50.
LindsayR.M., AlhejailiF., NesrallahG., LeitchR., ClementL., HeidenheimA.P.Calcium and phosphate balance with quotidian hemodialysis.Am J Kidney Dis2003; 42(Suppl): 24–9.
51.
ZehnderC., GutzwillerJ.P., RenggliK.Hemodiafiltration—a new treatment option for hyperphosphatemia in hemodialysis patients.Clin Nephrol1999; 52: 152–9.
52.
NolphK.D., TwardowskiZ.J., PopovichR.P., RubinJ.Equilibration of peritoneal dialysis solutions during long-dwell exchanges.J Lab Clin Med1979; 93: 246–56.
53.
GraffJ., FuglebergS., BrahmJ., Fogh–AndersenN.The transport of phosphate between the plasma and dialysate compartments in peritoneal dialysis is influenced by an electric potential difference.Clin Physiol1996; 16: 291–300.
54.
DelmezJ.A., SlatopolskyE., MartinK.J., GearingB.N., HarterH.R.Minerals, vitamin D, and parathyroid hormone in continuous ambulatory peritoneal dialysis.Kidney Int1982; 21: 862–7.
55.
WaniewskiJ., HeimbürgerO., WerynskiA., ParkM.S., LindholmB.Diffusive and convective solute transport in peritoneal dialysis with glucose as an osmotic agent.Artif Organs1995; 19: 295–306.
56.
GallarP., OrtegaO., GutiérrezM., MuñozM., HilaraL., OlietA.Influencing factors in the control of phosphorus in peritoneal dialysis. Therapeutic options (Spanish).Nefrologia2000; 20: 355–61.
57.
TwardowskiZ.J., NolphK.D., KhannaR., GluckZ., ProwantB.F., RyanL.P.Daily clearances with continuous ambulatory peritoneal dialysis and nightly peritoneal dialysis.ASAIO Trans1986; 32: 575–80.
58.
PirainoB., BenderF., BernardiniJ.A comparison of clearances on tidal peritoneal dialysis and intermittent peritoneal dialysis.Perit Dial Int1994; 14: 145–8.
JuergensenP., ErasJ., McClureB., KligerA.S., FinkelsteinF.O.The impact of various cycling regimens on phosphorus removal in chronic peritoneal dialysis patients.Int J Artif Organs2005; 28: 1219–23.
61.
DemetriouD., HabichtA., SchillingerM., HorlW.H., VychytilA.Adequacy of automated peritoneal dialysis with and without manual daytime exchange: a randomized controlled trial.Kidney Int2006; 70: 1649–55.
62.
PaniaguaR., AmatoD., VoneshE., Correa–RotterR., RamosA., MoranJ.Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial.J Am Soc Nephrol2002; 13: 1307–20.
