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NDT Advance Access published online on October 28, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp560
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© The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The effect of dialysis modality on phosphate control : haemodialysis compared to haemodiafiltration. The Pan Thames Renal Audit

Andrew Davenport1, Carrie Gardner2, Michael Delaney3 and on behalf of the Pan Thames Renal Audit Group4

1 UCL Centre for Nephrology, Royal Free Campus, University College London Medical School London, UK 2 Audit, Information & Analysis Unit, London Specialised Commissioning Group, London 3 Kent Kidney Care Centre, East Kent University NHS Foundation Trust, Canterbury, Kent, UK 4 Pan Thames Renal Audit Group—see list

Correspondence and offprint requests to: Correspondence and offprint requests to: Andrew Davenport; E-mail: andrew.davenport{at}royalfree.nhs.uk



  Abstract

Background and Objectives. Hyperphosphataemia is a primary risk factor for patients with end-stage kidney failure. Phosphate clearance by traditional thrice-weekly standard haemodialysis is inadequate for patients achieving recommended dietary protein goals. We investigated whether phosphate control was improved by adding convective clearance with haemodiafiltration.

Methods. We audited pre-midweek session calcium and phosphate levels in 5366 adult patients, 4515 treated by haemodialysis and 851 by on-line haemodiafiltration.

Results. The cohorts were similar for age, sex and dialysis vintage. Serum phosphate was lower in the haemodiafiltration cohort (1.42 ± 0.61 mmol/l) compared to the haemodialysis cohort (1.53 ± 0.53 mmol/l; P < 0.001), as was the calcium–phosphate product (3.31 ± 1.53 vs 3.5 ± 1.33 mmol2/l2, respectively; P < 0.001) despite a shorter treatment session time (3.68 ± 0.44 vs 3.92 ± 0.49 h; P < 0.001). Parathyroid hormone levels were similar.

Conclusions. The results of this audit suggest that haemodiafiltration offers improved phosphate control compared to standard intermittent haemodialysis.

Keywords: calcium; guidelines; haemodiafiltration; haemodialysis; phosphate

Received for publication: 4. 6.09
Accepted in revised form: 25. 9.09


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