Modifications to bicarbonate conductivity: A way to increase phosphate removal during hemodialysis? Proof of concept

• Published in: Hemodialysis international 2016-10, Vol.20 (4), p.601-609
• Main Authors: Bertocchio, Jean-Philippe, Mohajer, Médérick, Gaha, Khaled, Ramont, Laurent, Maheut, Hervé, Rieu, Philippe
• Format: Article
• Language: English
• Subjects: acid-base equilibrium; Aged; Bicarbonates - chemistry; Female; Humans; Hyperphosphatemia - therapy; Kidney Failure, Chronic - therapy; Male; Phosphates - blood; phosphorus; phosphorus metabolism disorders; Renal dialysis; Renal Dialysis - methods
• ISSN: 1492-7535; 1542-4758
• DOI: 10.1111/hdi.12423

Introduction Hyperphosphatemia and cardiovascular mortality are associated particularly with end‐stage renal disease. Available therapeutic strategies (i.e., diet restriction, calcium [or not]‐based phosphate binders, calcimimetics) are associated with extrarenal blood purification. Compartmentalization of phosphate limits its depuration during hemodialysis. Several studies suggest that plasmatic pH is involved in the mobilization of phosphate from intracellular to extracellular compartments. Consequently, the efficiency of modified bicarbonate conductivity to purify blood phosphate was tested. Methods Ten hemodialysis patients with chronic hyperphosphatemia (>2.1 mmol/L) were included in the two three–sessions‐per week periods. Bicarbonate concentration was fixed at 40 mmol/L and 30 mmol/L in the first and second periods, respectively. Phosphate depuration was evaluated by phosphate mobilization clearance (KM). Findings Although bicarbonatemia was lower during the second period (21.0 ± 2.7 vs. 24.4 ± 3.1 mmol/L, P