Hyperphosphatemia in patients with chronic kidney disease in hemodyalisis: risks and opportunities of correction


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Abstract

Aim. Estimation of prevalence of hyperphosphatemia and prognostic sighnificance of parameters, characterizing bone and mineral disorders in patients on hemodialysis. Methods. 70 prevalent hemodialysis and 175 new hemodialysis patients, in whom hemodialysis was started in one clinical center in 2006-2012 were included into the study. Multiple regression Cox analysis was performed with inclusion of mean levels during follow-up period of calciemia, phosphatemia, parathyroid hormone (PTH), demographic, clinical and laboratory parameters. Results. 63 patients of 245 died during follow-up period, 1-year mortality was 8%. Patients in middle tertile of phosphatemia (1,95-1,95 mmol/l) had 57% elevated mortality risk, patients in highest phosphatemia group (> 1,95 mmol/l) had more than 8-times elevation of mortality versus patients with lowest level of phopsphatemia (<1,59 mmol/l). Calciemia did not play a significant role as a prognstic parameter. Every 100 pg/ml elevation of PTH level was associated with 23% decrease of mortality risk. When PTH level was analyzed as categorial variable according to KDIGO recommendations, groups of patients with lower and higher level of this parameter were characterized with 29% and 69% elevation of mortality risk compared with patients with target PTH level (130-585 pg/ml). When KDOQI categories of PTH level was used, mortality risk was higher only in patients with parathyroid hormone level <150 pg/ml. Conclusion. Hyperphosphatemia in dialysis patients is frequent and associated with significant deterioration of prognosis. Existing approaches of its correction are suboptimal. There is convincing evidence that modern calcium-free phosphate binders allow significantly decrease mortality in patients on hemodialysis.

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