Learn about the
2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com: What are the main findings of the study?

We found that when hemodialysis sessions are matched to provide a similar eKT/V urea, phosphate removal increased by 40%, when time was extended from 4 to 8 h.

We also found that hourly phosphate removal is relatively stable, about 215 mg/h with conventional HD and 150 mg with extended HD.

The results were in accordance with our hypothesis that urea-based adequacy models could not predict the amount of phosphorus removed during hemodialysis.

Hemodialysis.com: Were any of the findings unexpected?

We expected that hourly phosphate removal would not differ much between the two prescriptions but, in fact, it did.

Hourly phosphate removal was about 40% higher with the conventional HD prescription.

Hemodialysis.com: What should clinicians and patients take away from your report? 

To properly deal with hyperphosphatemia it is critical to increase dialysis time and not frequency.

As figure 3 of the article shows one needs between five and half to six hours of conventional HD to match the amount of phosphorus removed with the extended procedure.

On the other hand, in terms of phosphorus removal, provided that flow prescriptions are kept the same (Qs 300 ml/min and Qd 500 ml/min), there is little benefit of switching from a conventional dialysis (3 x 4 hours / week) to a short daily schedule (6 x 2 hours / week).

Hemodialysis.com : What recommendations do you have for future research as a result of this study?  

We feel that clinical trials centered on phosphate balance are necessary to better define the need to adjust dialysis time and frequency.

The long term benefits associated with a phosphate centered hemodialysis adequacy approach should be examined.

Reference:

Phosphate Mass Removal during Hemodialysis: A Comparison between eKT/V-Matched Conventional and Extended Dialysis.

Sampaio MS, Ruzany F, Dorigo DM, Suassuna JH.
Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.
Am J Nephrol. 2012 Jul 7;36(2):121-126.
[Epub ahead of print]