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Effects of frequent hemodialysis on measures of CKD mineral and bone disorder.
J Am Soc Nephrol. 2012 Apr; 23(4):727-38.JA

Abstract

More frequent hemodialysis sessions and longer session lengths may offer improved phosphorus control. We analyzed data from the Frequent Hemodialysis Network Daily and Nocturnal Trials to examine the effects of treatment assignment on predialysis serum phosphorus and on prescribed dose of phosphorus binder, expressed relative to calcium carbonate on a weight basis. In the Daily Trial, with prescribed session lengths of 1.5-2.75 hours six times per week, assignment to frequent hemodialysis associated with both a 0.46 mg/dl decrease (95% confidence interval [95% CI], 0.13-0.78 mg/dl) in mean serum phosphorus and a 1.35 g/d reduction (95% CI, 0.20-2.50 g/d) in equivalent phosphorus binder dose at month 12 compared with assignment to conventional hemodialysis. In the Nocturnal Trial, with prescribed session lengths of 6-8 hours six times per week, assignment to frequent hemodialysis associated with a 1.24 mg/dl decrease (95% CI, 0.68-1.79 mg/dl) in mean serum phosphorus compared with assignment to conventional hemodialysis. Among patients assigned to the group receiving six sessions per week, 73% did not require phosphorus binders at month 12 compared with only 8% of patients assigned to sessions three times per week (P<0.001). At month 12, 42% of patients on nocturnal hemodialysis required the addition of phosphorus into the dialysate to prevent hypophosphatemia. Frequent hemodialysis did not have major effects on calcium or parathyroid hormone concentrations in either trial. In conclusion, frequent hemodialysis facilitates control of hyperphosphatemia and extended session lengths could allow more liberal diets and freedom from phosphorus binders.

Authors+Show Affiliations

University of Illinois at Chicago, Chicago, IL 60612, USA. jtdaugir@uic.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

22362907

Citation

Daugirdas, John T., et al. "Effects of Frequent Hemodialysis On Measures of CKD Mineral and Bone Disorder." Journal of the American Society of Nephrology : JASN, vol. 23, no. 4, 2012, pp. 727-38.
Daugirdas JT, Chertow GM, Larive B, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol. 2012;23(4):727-38.
Daugirdas, J. T., Chertow, G. M., Larive, B., Pierratos, A., Greene, T., Ayus, J. C., Kendrick, C. A., James, S. H., Miller, B. W., Schulman, G., Salusky, I. B., & Kliger, A. S. (2012). Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. Journal of the American Society of Nephrology : JASN, 23(4), 727-38. https://doi.org/10.1681/ASN.2011070688
Daugirdas JT, et al. Effects of Frequent Hemodialysis On Measures of CKD Mineral and Bone Disorder. J Am Soc Nephrol. 2012;23(4):727-38. PubMed PMID: 22362907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. AU - Daugirdas,John T, AU - Chertow,Glenn M, AU - Larive,Brett, AU - Pierratos,Andreas, AU - Greene,Tom, AU - Ayus,Juan Carlos, AU - Kendrick,Cynthia A, AU - James,Sam H, AU - Miller,Brent W, AU - Schulman,Gerald, AU - Salusky,Isidro B, AU - Kliger,Alan S, AU - ,, Y1 - 2012/02/23/ PY - 2012/2/25/entrez PY - 2012/3/1/pubmed PY - 2012/5/23/medline SP - 727 EP - 38 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 23 IS - 4 N2 - More frequent hemodialysis sessions and longer session lengths may offer improved phosphorus control. We analyzed data from the Frequent Hemodialysis Network Daily and Nocturnal Trials to examine the effects of treatment assignment on predialysis serum phosphorus and on prescribed dose of phosphorus binder, expressed relative to calcium carbonate on a weight basis. In the Daily Trial, with prescribed session lengths of 1.5-2.75 hours six times per week, assignment to frequent hemodialysis associated with both a 0.46 mg/dl decrease (95% confidence interval [95% CI], 0.13-0.78 mg/dl) in mean serum phosphorus and a 1.35 g/d reduction (95% CI, 0.20-2.50 g/d) in equivalent phosphorus binder dose at month 12 compared with assignment to conventional hemodialysis. In the Nocturnal Trial, with prescribed session lengths of 6-8 hours six times per week, assignment to frequent hemodialysis associated with a 1.24 mg/dl decrease (95% CI, 0.68-1.79 mg/dl) in mean serum phosphorus compared with assignment to conventional hemodialysis. Among patients assigned to the group receiving six sessions per week, 73% did not require phosphorus binders at month 12 compared with only 8% of patients assigned to sessions three times per week (P<0.001). At month 12, 42% of patients on nocturnal hemodialysis required the addition of phosphorus into the dialysate to prevent hypophosphatemia. Frequent hemodialysis did not have major effects on calcium or parathyroid hormone concentrations in either trial. In conclusion, frequent hemodialysis facilitates control of hyperphosphatemia and extended session lengths could allow more liberal diets and freedom from phosphorus binders. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/22362907/Effects_of_frequent_hemodialysis_on_measures_of_CKD_mineral_and_bone_disorder_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=22362907 DB - PRIME DP - Unbound Medicine ER -