Phosphate levels in patients treated with low-flux haemodialysis, pre-dilution haemofiltration and haemodiafiltration: Post hoc analysis of a multicentre, randomized and controlled trial

Francesco Locatelli, Paolo Altieri, Simeone Andrulli, Giovanna Sau, Piergiorgio Bolasco, Luciano A. Pedrini, Carlo Basile, Salvatore David, Luanna Gazzanelli, Guido Tampieri, Elisabetta Isola, Onofrio Marzolla, Bruno Memoli, Marino Ganadu, Ernesto Reina, Silvio Bertoli, Rocco Ferrara, Domenica Casu, Francesco Logias, Renzo TarchiniGiovanni Mattana, Mario Passaghe, Gianfranco Fundoni, Giuseppe Villa, Biagio Raffaele Di Iorio, Giuseppe Pontoriero, Carmine Zoccali

Research output: Contribution to journalArticle

Abstract

Background. Whether convective therapies allow better control of serum phosphate (P) is still undefined, and no data are available concerning on-line haemofiltration (HF). The objectives of the study are to evaluate the effect of convective treatments (CTs) on P levels in comparison with low-flux haemodialysis (HD) and to evaluate the correlates of serum phosphate in a post hoc analysis of a randomized clinical trial. Methods. This analysis was performed in the database of a multicentre, open label and randomized controlled study in which 146 chronic HD patients from 27 Italian centres were randomly assigned to HD (70 patients) or CTs: on-line pre-dilution HF (36 patients) or on-line pre-dilution haemodiafiltration (40 patients). Results. CTs did not affect P (P = 0.526), calcium (Ca) (P = 0.849) and parathyroid hormone levels (P = 0.622). P levels were associated with the use of phosphate binders including aluminium- based phosphate binders (P <0.001) and sevelamer (P <0.001), pre-dialysis bicarbonate levels (P <0.001) and predialysis blood K levels (P <0.001). On multivariate analysis (generalized linear model), serum P was again largely unassociated with CTs (P = 0.631). Notably, participating centres were by far the strongest independent correlate of serum P, explaining 45.3% of the variance of serum P over the trial and this association was confirmed at multivariate analysis. Bicarbonate (P <0.001) and, to a weaker extent, serum K (P = 0.032) were independently related to serum P. Conclusions. In comparison with low-flux HD, CTs did not significantly affect serum P levels. Participating centres were the main source of P variability during the trial followed by treatment with phosphate binders, serum bicarbonate and, to a weak extent, serum potassium levels (ClinicalTrials.gov Identifier: NCT011583309).

Original languageEnglish
Pages (from-to)1239-1246
Number of pages8
JournalNephrology Dialysis Transplantation
Volume29
Issue number6
DOIs
Publication statusPublished - 2014

Keywords

  • convective therapies
  • haemodialysis
  • on-line haemodiafiltration
  • on-line haemofiltration
  • phosphate

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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    Locatelli, F., Altieri, P., Andrulli, S., Sau, G., Bolasco, P., Pedrini, L. A., Basile, C., David, S., Gazzanelli, L., Tampieri, G., Isola, E., Marzolla, O., Memoli, B., Ganadu, M., Reina, E., Bertoli, S., Ferrara, R., Casu, D., Logias, F., ... Zoccali, C. (2014). Phosphate levels in patients treated with low-flux haemodialysis, pre-dilution haemofiltration and haemodiafiltration: Post hoc analysis of a multicentre, randomized and controlled trial. Nephrology Dialysis Transplantation, 29(6), 1239-1246. https://doi.org/10.1093/ndt/gfu031