Elias Rosilene M, Alvares Valeria R C, Moysés Rosa M A
Department of Medicine, Renal Division, Universidade de São Paulo, São Paulo, Brazil.
Universidade Nove de Julho, UNINOVE, São Paulo, Brazil.
Kidney Blood Press Res. 2018;43(1):110-114. doi: 10.1159/000487108. Epub 2018 Jan 31.
BACKGROUND/AIMS: Hyperphosphatemia is associated with high mortality rate in patients on dialysis. Conventional hemodialysis (HD) is a limit technique in removing phosphate (P). There is a widespread belief that P is removed mainly in the first hour of HD. The aim of this study was to certify the percentage of 1-hour removal of P as compared to the entire procedure.
data from the first dialysis of the week of 21 patients (13 men, age 44±15 years), for 3 consecutive dialysis sessions were evaluated. Fresh dialysate samples were collected at 1 hour and at the end of the session from a partial spent dialysate collection method.
Pre dialysis serum P was 4.7±1.7 mg/dl. Reduction rate of serum P was 47.4 ± 14.3 and 45.1 ± 10.8% in 1- and 4-hour of HD, respectively (p=0.322). P removal was 194 (145, 242) mg in 1-hour (p<0.0001), which represents 25.0 ± 0.2% of the total removed during the entire HD. Patients with pre dialysis P ≥ 5.5mg/dl had higher P removal during HD than those with P < 5.5mg/dl [975 (587, 1354) vs. 776 (580, 784) mg, p=0.025], although the percentage of removal in 1 hour was not different from those with P < 5.5mg/d (24.9 ± 0.3 vs. 25.0 ± 0.1%, p=0.918). P removal during dialysis correlated with pre dialysis serum P (r=0.455, p=0.001), parathormone (r=0.264, p=0.037) and ultrafiltration volume (r=0.343, p=0.019).
despite the P serum concentration normalizing in the first hour of hemodialysis, the removal in the same period reaches only 25% of the entire session.
背景/目的：高磷血症与透析患者的高死亡率相关。传统血液透析（HD）在清除磷酸盐（P）方面是一种有限的技术。人们普遍认为磷主要在血液透析的第一个小时被清除。本研究的目的是确定与整个过程相比，1小时内磷的清除百分比。
对21例患者（13名男性，年龄44±15岁）连续3次透析治疗中每周第一次透析的数据进行评估。采用部分用过的透析液收集方法，在1小时和透析结束时收集新鲜透析液样本。
透析前血清磷为4.7±1.7mg/dl。血液透析1小时和4小时时血清磷的降低率分别为47.4±14.3%和45.1±10.8%（p=0.322）。1小时内磷清除量为194（145，242）mg（p<0.0001），占整个血液透析过程中总清除量的25.0±0.2%。透析前磷≥5.5mg/dl的患者在血液透析期间的磷清除量高于磷<5.5mg/dl的患者[975（587，1354）mg对776（580，784）mg，p=0.025]，尽管1小时内的清除百分比与磷<5.5mg/dl的患者没有差异（24.9±0.3%对25.0±0.1%，p=0.918）。透析期间的磷清除与透析前血清磷（r=0.455，p=0.001）、甲状旁腺激素（r=0.264，p=0.037）和超滤量（r=0.343，p=0.019）相关。
尽管血液透析第一小时血清磷浓度恢复正常，但该时段的清除量仅占整个疗程的25%。
