Phosphate clearance in peritoneal dialysis

In renal failure, hyperphosphatemia is common and correlates with increased mortality making phosphate removal a key priority for dialysis therapy. We investigated phosphate clearance, removal and serum level, and factors associated with phosphate control in patients undergoing continuous ambulatory (CAPD), continuous cyclic (CCPD) and automated (APD) peritoneal dialysis (PD). In 154 prevalent PD patients (mean age 53.2 +/- 17.6 year, 59% men, 47% anuric), 196 daily collections of urine and 368 collections of dialysate were evaluated in terms of renal, peritoneal and total (renal plus peritoneal) phosphorus removal (g/week), phosphate and creatinine clearances (L/week) and urea KT/V. Dialytic removal of phosphorus was lower in APD (1.34 +/- 0.62 g/week) than in CAPD (1.89 +/- 0.73 g/week) and CCPD (1.91 +/- 0.63 g/week) patients; concomitantly, serum phosphorus was higher in APD than in CAPD (5.55 +/- 1.61 vs. 4.84 +/- 1.23 mg/dL; p<0.05). Peritoneal and total phosphate clearances correlated with peritoneal (rho=0.93) and total (rho=0.85) creatinine clearances (p<0.001) but less with peritoneal and total urea KT/V (rho=0.60 and rho=0.65, respectively, p<0.001). Phosphate removal, clearance and serum levels differed between PD modalities. CAPD was associated with higher peritoneal removal and lower serum level of phosphate than APD.