Effect of long hours hemodialysis on phosphate clearance

High blood phosphate is linked to higher rate of death, heart attacks and strokes in dialysis patients. Treatment to lower phosphate includes oral phosphate binders and modification of diet. Conventional maintenance haemodialysis of 4 hours X three times a week is inadequate to significantly contribute to removing phosphate. An expansion of home-haemodialysis programmes with long hours of dialysis at night has resulted in a significant number of patients coming off oral phosphate binder tablets because of excellent phosphate control. Phosphate kinetics is complex and not well-understood in long hours dialysis. Understanding phosphate kinetics helps us design equations to calculate the exact amount of phosphate removed with each dialysis session and develop accurate dialysis prescriptions. We would further like to examine the role of parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) on phosphate kinetics during dialysis.

Aims: The aim of the study is to study how much phosphate is removed at regular time intervals into dialysis in long hours dialysis and the effect of PTH and FGF23 on phosphate removal.