Effects of frequent hemodialysis on measures of CKD mineral and bone disorder
- PMID: 22362907
- PMCID: PMC3312501
- DOI: 10.1681/ASN.2011070688
Effects of frequent hemodialysis on measures of CKD mineral and bone disorder
Abstract
More frequent hemodialysis sessions and longer session lengths may offer improved phosphorus control. We analyzed data from the Frequent Hemodialysis Network Daily and Nocturnal Trials to examine the effects of treatment assignment on predialysis serum phosphorus and on prescribed dose of phosphorus binder, expressed relative to calcium carbonate on a weight basis. In the Daily Trial, with prescribed session lengths of 1.5-2.75 hours six times per week, assignment to frequent hemodialysis associated with both a 0.46 mg/dl decrease (95% confidence interval [95% CI], 0.13-0.78 mg/dl) in mean serum phosphorus and a 1.35 g/d reduction (95% CI, 0.20-2.50 g/d) in equivalent phosphorus binder dose at month 12 compared with assignment to conventional hemodialysis. In the Nocturnal Trial, with prescribed session lengths of 6-8 hours six times per week, assignment to frequent hemodialysis associated with a 1.24 mg/dl decrease (95% CI, 0.68-1.79 mg/dl) in mean serum phosphorus compared with assignment to conventional hemodialysis. Among patients assigned to the group receiving six sessions per week, 73% did not require phosphorus binders at month 12 compared with only 8% of patients assigned to sessions three times per week (P<0.001). At month 12, 42% of patients on nocturnal hemodialysis required the addition of phosphorus into the dialysate to prevent hypophosphatemia. Frequent hemodialysis did not have major effects on calcium or parathyroid hormone concentrations in either trial. In conclusion, frequent hemodialysis facilitates control of hyperphosphatemia and extended session lengths could allow more liberal diets and freedom from phosphorus binders.
Figures




Comment in
-
Mineral metabolism outcomes with frequent hemodialysis.Nat Rev Nephrol. 2012 Mar 13;8(5):254. doi: 10.1038/nrneph.2012.56. Nat Rev Nephrol. 2012. PMID: 22410494 No abstract available.
Similar articles
-
Intensive Hemodialysis, Mineral and Bone Disorder, and Phosphate Binder Use.Am J Kidney Dis. 2016 Nov;68(5S1):S24-S32. doi: 10.1053/j.ajkd.2016.05.024. Am J Kidney Dis. 2016. PMID: 27772640 Review.
-
Nocturnal but not short hours quotidian hemodialysis requires an elevated dialysate calcium concentration.J Am Soc Nephrol. 2003 Sep;14(9):2322-8. doi: 10.1097/01.asn.0000083044.42480.c1. J Am Soc Nephrol. 2003. PMID: 12937309
-
[Changes in mineral metabolism in stage 3, 4, and 5 chronic kidney disease (not on dialysis)].Nefrologia. 2008;28 Suppl 3:67-78. Nefrologia. 2008. PMID: 19018742 Spanish.
-
Phosphorus Counting Table for the control of serum phosphorus levels without phosphate binders in hemodialysis patients.Clin Nutr ESPEN. 2019 Aug;32:153-157. doi: 10.1016/j.clnesp.2019.03.008. Epub 2019 Apr 20. Clin Nutr ESPEN. 2019. PMID: 31221281
-
Effectiveness of phosphate binders in adult patients with end stage renal disease receiving hemodialysis: a systematic review.JBI Database System Rev Implement Rep. 2019 Jan;17(1):49-73. doi: 10.11124/JBISRIR-2017-003740. JBI Database System Rev Implement Rep. 2019. PMID: 30204711
Cited by
-
The Involvement of Notch1-RBP-Jk/Msx2 Signaling Pathway in Aortic Calcification of Diabetic Nephropathy Rats.J Diabetes Res. 2017;2017:8968523. doi: 10.1155/2017/8968523. Epub 2017 Dec 31. J Diabetes Res. 2017. PMID: 29464183 Free PMC article.
-
Effect of extended hours dialysis on markers of chronic kidney disease-mineral and bone disorder in the ACTIVE Dialysis study.BMC Nephrol. 2019 Jul 12;20(1):258. doi: 10.1186/s12882-019-1438-3. BMC Nephrol. 2019. PMID: 31299919 Free PMC article. Clinical Trial.
-
The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach.Nutrients. 2017 Apr 10;9(4):372. doi: 10.3390/nu9040372. Nutrients. 2017. PMID: 28394304 Free PMC article. Review.
-
Interventions for fatigue in people with kidney failure requiring dialysis.Cochrane Database Syst Rev. 2023 Aug 31;8(8):CD013074. doi: 10.1002/14651858.CD013074.pub2. Cochrane Database Syst Rev. 2023. PMID: 37651553 Free PMC article. Review.
-
Risk of Band Keratopathy in Patients with End-Stage Renal Disease.Sci Rep. 2016 Jun 27;6:28675. doi: 10.1038/srep28675. Sci Rep. 2016. PMID: 27346848 Free PMC article.
References
-
- Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM: Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 15: 2208–2218, 2004 - PubMed
-
- Hruska KA, Teitelbaum SL: Renal osteodystrophy. N Engl J Med 333: 166–174, 1995 - PubMed
-
- Kidney Disease Improving Global Outcomes (KDIGO) CKD-MBD Work Group: KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 113: S1–S130, 2009 - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical