University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Nephrol Dial Transplant. 2022 Nov 23;37(12):2522-2527. doi: 10.1093/ndt/gfac223.
To what extent hemodiafiltration (HDF) improves management of hyperphosphatemia over hemodialysis (HD) is a subject of ongoing investigation.
We modified a previously described phosphate kinetic model to include incorporation of EUDIAL recommended equations for hemodiafiltration (HDF) clearance. We used the model to predict the recovery of phosphate from spent dialysate/hemofiltrate and compared this with averaged data from five published studies. Mean study average predialysis serum phosphate was 1.81 ± 0.20 mmol/L. Session length was close to 240 min per treatment. All HDF was done postdilution, at an average rate of 65 ± 24 mL/min.
Measured mean phosphate removal was 1039 ± 136 mg (33.5 ± 4.41 mmol, slightly lower than the model-predicted mean value of 1092 ± 127 mg (35.3 ± 4.09 mmol). The measured ratio of phosphate removal with HDF compared with HD averaged 1.15 ± 0.22, ranging from 1.01 to 1.44. Using mean study input parameters for patient size and treatment characteristics, the predicted ratio of phosphate removal with HDF compared with HD averaged 1.095 ± 0.029, ranging from 1.05 to 1.13.
Addition of EUDIAL-recommended convective clearance equations to a phosphate kinetic model predicts a 10% or greater benefit in terms of phosphate removal for HDF compared with HD at typical dialysis and hemodiafiltration treatment settings. These predictions are similar to the HDF advantage reported in the literature in studies where phosphate removal has been measured in spent dialysate.
血液透析滤过（HDF）在多大程度上优于血液透析（HD）改善高磷血症的管理是一个正在研究的课题。
我们修改了以前描述的磷酸盐动力学模型，纳入了 EUDIAL 推荐的血液透析滤过（HDF）清除方程。我们使用该模型预测从废弃透析液/血液滤过液中回收的磷酸盐，并将其与五项已发表研究的平均数据进行比较。平均研究平均预透析血清磷酸盐为 1.81 ± 0.20 mmol/L。治疗时间接近每次治疗 240 分钟。所有 HDF 均在后稀释下进行，平均速率为 65 ± 24 mL/min。
测量的平均磷酸盐去除率为 1039 ± 136 mg（33.5 ± 4.41 mmol，略低于模型预测的 1092 ± 127 mg（35.3 ± 4.09 mmol）的平均值。HDF 与 HD 相比的磷酸盐去除率测量比值平均为 1.15 ± 0.22，范围为 1.01 至 1.44。使用患者大小和治疗特征的平均研究输入参数，HDF 与 HD 相比的磷酸盐去除预测比值平均为 1.095 ± 0.029，范围为 1.05 至 1.13。
在磷酸盐动力学模型中添加 EUDIAL 推荐的对流清除方程预测，在典型的透析和血液透析滤过治疗设置下，与 HD 相比，HDF 在磷酸盐去除方面具有 10%或更高的优势。这些预测与文献中报告的 HDF 优势相似，其中在废弃透析液中测量了磷酸盐去除。
