Predialysis serum phosphate levels according to hemodialysis shift: Circadian rhythm matters

Dario, Ketili Alice; Dalboni, Maria Aparecida; Silva, Bruno C. da; Martins, Carolina Steller Wagner; Araujo, Luiza Karla R P; Elias, Rosilene Motta; Moysés, Rosa Maria Affonso

doi:10.1111/hdi.12882

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…There are circadian fluctuations in phosphate levels in patients with CKD, even those on dialysis [41]. In a study of 147 haemodialysis patients [42], hyperphosphatemia was more common during the morning shift and phosphate levels were higher in the fasting state than in the postprandial state. The assessment of serum phosphate is challenging not only because of such fluctuations [43] but also because biochemical assays measure only a small proportion of the total phosphate [44].…”

Section: Phosphate Balance In Dialysismentioning

confidence: 99%

Phosphate balance during dialysis and after kidney transplantation in patients with chronic kidney disease

Duque

Elias

Moysés

2022

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewIn patients with chronic kidney disease (CKD), hyperphosphatemia is associated with several adverse outcomes, including bone fragility and progression of kidney and cardiovascular disease. However, there is a knowledge gap regarding phosphate balance in CKD. This review explores its current state, depending on the stage of CKD, dialysis modalities, and the influence of kidney transplantation.Recent findingsAdequate phosphate control is one of the goals of treatment for CKD-mineral and bone disorder. However, ongoing studies are challenging the benefits of phosphate-lowering treatment. Nevertheless, the current therapy is based on dietary restriction, phosphate binders, and optimal removal by dialysis. In the face of limited adherence, due to the high pill burden, adjuvant options are under investigation. The recent discovery that intestinal absorption of phosphate is mostly paracellular when the intraluminal concentration is adequate might help explain why phosphate is still well absorbed in CKD, despite the lower levels of calcitriol.SummaryFuture studies could confirm the benefits of phosphate control. Greater understanding of the complex distribution of phosphate among the body compartments will help us define a better therapeutic strategy in patients with CKD.

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Section: Phosphate Balance In Dialysismentioning

confidence: 99%

Phosphate balance during dialysis and after kidney transplantation in patients with chronic kidney disease

Duque

Elias

Moysés

2022

Current Opinion in Nephrology &Amp; Hypertension

Self Cite

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Routine laboratory testing in hemodialysis: how frequently is it needed?

et al. 2022

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Background: Hemodialysis patients are followed by routine laboratory testing. There is uncertainty whether these tests always lead to a change in decision-making. This study aims to discover the number of yearly interventions/changes in prescription based on these tests and depict the group of patients who would benefit from reduced or increased laboratory blood tests. Methods: This is a multi-center retrospective study that included patients on hemodialysis for more than one year. Laboratory data collected included yearly average of hemoglobin, urea reduction ratio (URR), serum phosphate, calcium, potassium, parathormone (PTH), ferritin and transferrin saturation (TSAT); changes in prescription of erythropoietin-stimulating agents (ESAs), intravenous (IV) iron, alfacalcidol, phosphate binders and dialysis parameters were retrieved from medical records. A multivariate regression analysis assessed factors associated with high number of interventions. Results: A total of 210 hemodialysis patients were included: 62.4% males, 47.1% diabetics. Their median age was 72 (62,78.5) years. Their laboratory parameters were within KDIGO targets. The median number of yearly interventions was 5 (3,7) for ESAs, 4 (2,6) for IV iron, 1 (0,2.25) for phosphate binders, 0 (0,1) for alfacalcidol. Based on the multivariate analysis, patients with higher ferritin, frequent changes in ESA, more changes in alfacalcidol and higher PTH had higher number of prescription’s changes in ESA, IV iron, phosphate binders and alfacalcidol respectively. Conclusion: While maintaining KDIGO targets, therapeutic interventions following routine laboratory testing did not exceed six times yearly for all parameters. This suggests that a reduced testing frequency in hemodialysis patients is possible without any impact on quality of care. A personalized approach remains safe for hemodialysis patients while reducing the cost. This is very relevant in low-resource settings and during economic crises and needs to be evaluated in prospective studies.

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