A Kinetic Model of Inorganic Phosphorus Mass Balance in Hemodialysis Therapy

Gotch, Frank A.; Panlilio, Froilan; Sergeyeva, Olga; Rosales, Laura; Folden, Tom; Kaysen, George A.; Levin, Nathan W.

doi:10.1159/000067866

Cited by 70 publications

(57 citation statements)

References 1 publication

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“…Sugasaki et al (21,22) and Gotch et al (35) proposed modified one-compartment models; the former proposed the incorporation of a time- Table 2. Estimated values of patient parameters from short hemodialysis (SHD) and conventional hemodialysis (CHD) sessions dependent phosphorus generation rate, and the latter empirically fit data to an equation derived from a one-compartment model.…”

Section: Discussionmentioning

confidence: 99%

Kinetic Model of Phosphorus Mobilization during and after Short and Conventional Hemodialysis

Agar

Akonur

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The kinetics of plasma phosphorus (inorganic phosphorus or phosphate) during hemodialysis treatments cannot be explained by conventional one-or two-compartment models; previous approaches have been limited by assuming that the distribution of phosphorus is confined to classical intracellular and extracellular fluid compartments. In this study a novel pseudo one-compartment model, including phosphorus mobilization from a large second compartment, was proposed and evaluated.Design, setting, participants, & measurements Clinical data were obtained during a crossover study where 22 chronic hemodialysis patients underwent both short (2-hour) and conventional (4-hour) hemodialysis sessions. The model estimated two patient-specific parameters, phosphorus mobilization clearance and phosphorus central distribution volume, by fitting frequent intradialytic and postdialytic plasma phosphorus concentrations using nonlinear regression.Results Phosphorus mobilization clearances varied among patients (45 to 208 ml/min), but estimates during short (98 Ϯ 44 ml/min, mean Ϯ SD) and conventional (99 Ϯ 47 ml/min) sessions were not different (P ϭ 0.74) and correlated with each other (concordance correlation coefficient c of 0.85). Phosphorus central distribution volumes for each patient (short: 11.0 Ϯ 4.2 L and conventional: 11.9 Ϯ 3.8 L) were also correlated ( c of 0.45). ConclusionsThe reproducibility of patient-specific parameters during short and conventional hemodialysis treatments suggests that a pseudo one-compartment model is robust and can describe plasma phosphorus kinetics under conditions of clinical interest.

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Section: Discussionmentioning

confidence: 99%

Kinetic Model of Phosphorus Mobilization during and after Short and Conventional Hemodialysis

Agar

Akonur

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…A series of studies quantifying these important relationships have been reported from the Renal Research Institute in New York [28,29,30,31,32,33,34] but are not often considered in the discussion of the dialysis prescription [1,2,3]. As shown in figure 16 P is widely distributed in all protein-rich foodstuffs and particularly in dairy products.…”

Section: Errors In Delivery Of the Prescribed Cdinamentioning

confidence: 99%

“…Calculation of calcium absorbed and removed with calcium kinetic modeling [for more details, see [28,29,30,31,32,33,34]].…”

Section: Errors In Delivery Of the Prescribed Cdinamentioning

confidence: 99%

How Can We Improve the Solute and Fluid Transport Prescriptions in Hemodialysis to Improve Patient Outcomes?

Gotch

Kotanko²,

Levin³

2013

Blood Purif

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Improvements in the dialysis prescription can only be achieved by changes in solute and water transport which provide better control of the metabolic uremic abnormalities that are amenable to dialysis. The key abnormalities identified here are protein catabolites, fluid and electrolyte balance, calcium and phosphorus balance and bone metabolism and acid-base balance. The history of the dialysis prescription is reviewed and changes which might improve the control of these metabolic systems are described. This review concludes there is no support for the recommendation of the routine application of long treatment time and routine use of hemodiafiltration.

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“…Ideally, adequate dialysis in any form would remove adequate amounts of all uremic toxins, including phosphorus. Unfortunately, conventional, thrice-weekly hemodialysis (4 h duration) removes approximately 900 mg of phosphorus each treatment (an average of only 300 mg/d) (18). Conventional, intermittent hemodiafiltration improves phosphorus removal modestly (1030 to 1700 mg/treatment) (19), but overall, conventional, intermittent hemodialysis provides inadequate removal of phosphorus.…”

Section: Dialysismentioning

confidence: 99%

Control of Hyperphosphatemia among Patients with ESRD

Coladonato¹

2005

Journal of the American Society of Nephrology

102

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Derangements of mineral metabolism occur during the early stages of chronic kidney disease (CKD). Hyperphosphatemia develops in the majority of patients with ESRD and has long been associated with progression of secondary hyperparathyroidism and renal osteodystrophy. More recent observational data have associated hyperphosphatemia with increased cardiovascular mortality among dialysis patients. Adequate control of serum phosphorus remains a cornerstone in the clinical management of patients with CKD not only to attenuate the progression of secondary hyperparathyroidism but also possibly to reduce the risk for vascular calcification and cardiovascular mortality. These measures include dietary phosphorus restriction, dialysis, and oral phosphate binders. Dietary restriction is limited in advanced stages of CKD. Phosphate binders are necessary to limit dietary absorption of phosphorus. Aluminum hydroxide is an efficient binder; however, its use has been nearly eliminated because of concerns of toxicity. Calcium salts are inexpensive and have been used effectively worldwide as an alternative to aluminum. Concerns of calcium overload have led to the investigation of alternatives. Currently, only two Food and Drug Administration-approved noncalcium, nonaluminum binders are available. Sevelamer hydrochloride is an exchange resin and was not as effective as calcium acetate in meeting new guideline recommendations in one double-blind clinical trial. Lanthanum carbonate is a rare earth element and has been studied less extensively. Concerns of long-term administration and toxicity exist. Furthermore, these agents are significantly more expensive than calcium salts, which may contribute to patient noncompliance.

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A Kinetic Model of Inorganic Phosphorus Mass Balance in Hemodialysis Therapy

Cited by 70 publications

References 1 publication

Kinetic Model of Phosphorus Mobilization during and after Short and Conventional Hemodialysis

Kinetic Model of Phosphorus Mobilization during and after Short and Conventional Hemodialysis

How Can We Improve the Solute and Fluid Transport Prescriptions in Hemodialysis to Improve Patient Outcomes?

Control of Hyperphosphatemia among Patients with ESRD

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