Intensive hemodialysis (HD), particularly nocturnal HD, reduces serum phosphorus levels and decreases the need for phosphate binders, investigators concluded in a new review.

“Hyperphosphatemia is a ubiquitous complication of end-stage renal disease,” Michael Copland, MD, of the University of British Columbia in Vancouver, and colleagues concluded in the American Journal of Kidney Diseases (2016;68:S51-S58). “Upon detailed examination of dietary phosphorus intake and dialytic clearance, much of the need for phosphate binders can be attributed to the cumulative number of hours of treatment with conventional HD. Intensive HD is an efficacious intervention for hyperphosphatemia and can lower or eliminate the need for phosphate binders.”

The authors also concluded that “intensive HD appears to have no meaningful effects on serum calcium and parathyroid hormone levels.”

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In their review, Dr Copland’s group noted that short daily and nocturnal schedules in the Frequent Hemodialysis Network (FHN) trial reduced serum phosphorus levels by 0.6 and 1.6 mg/dL, respectively, relative to 3 sessions per week. In the daily arm of the FHN trial, intensive HD significantly lowered estimated phosphate binder dose per day; in the nocturnal arm, intensive HD led to binder discontinuation in 75% of patients, Dr Copland and colleagues noted.

In addition, Dr Copland’s group cited a single-center prospective cohort study by Juan Carlos Ayus, MD, and colleagues published in Kidney International (2007;71:336-342) showing that mean cumulative phosphorus clearance was 2452 mg/week with short daily HD (6 sessions per week each lasting 3 hours) compared with only 1572 mg/week with conventional HD (3 sessions per week each lasting 4 hours). Mean serum phosphorus levels with short daily HD fell from 6.26 mg/dL at baseline to 4.58 and 4.20 mg/dL after 6 and 12 months of follow-up, respectively. In the conventional HD arm, mean serum phosphorus levels remained near 5 mg/dL during follow-up.

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