Residual Renal Phosphate Clearance in Patients Receiving Hemodialysis or Hemodiafiltration

Abstract

Substantial levels of residual renal clearance and urine output may occur in patients treated with hemodialysis or hemodiafiltration. However, the relationships among residual renal urea, creatinine, and phosphate clearances, respectively, and between clearances and urine volume have not been well described. We performed a prospective, cross-sectional study which enrolled hemodialysis and hemodiafiltration patients with a urine volume of >100mL/day, in whom at least 2 residual renal clearances were obtained over a 6-month observation period. Urine was collected for 24hours prior to the midweek treatment session and concentrations of urea, creatinine, and phosphate were measured. Thirty-eight patients (24 men, 14 women) with a mean age of 70.4±12.4 (SD) years were included in this analysis. All patients were dialyzed 3 times per week with mean treatment duration of 243±7.89minutes. Twenty patients were undergoing hemodiafiltration and 18 patients high-flux hemodialysis. In total, 102 dialysis sessions, of which 52 were hemodiafiltration, and urine collections were analyzed. Mean urine volume was 457±254mL per 24hours. Residual renal clearance rates of urea (Kr Urea), creatinine (Kr Cr), and phosphate (Kr Phos) were 1.60±0.979, 4.69±3.79, and 1.98±1.36mL/minute, respectively. Mean ratios of Kr Cr/Kr Urea, Kr Phos/Kr Urea, and Kr Phos/Kr Cr were 2.83±1.21, 1.23±0.387, and 0.477±0.185, respectively. There was a modest correlation between Kr Phos and daily urine volume (r=0.605, P=.001). In maintenance hemodialysis and hemodiafiltration patients, residual renal phosphate clearance is approximately 23% higher than residual renal urea clearance. Urine volume is a modestly accurate surrogate for estimating residual renal phosphate clearance, but only when urine volume is <300mL/day.