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KMID : 0359920140330010058
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Korean Journal of Nephrology
2014 Volume.33 No. 1 p.58 ~ p.64
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Signi?cance of residual renal function for phosphate control in chronic hemodialysis patients
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Rhee Ha-Rin
Yang Ji-Young
Jung Woo-Jin
Shin Min-Ji
Yang Byung-Yoon
Song Sang-Heon
Kwak Ihm-Soo
Seong Eun-Young
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Abstract
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Background: The aim of this study was to compare mineral metabolism between anuric and nonanuric chronic hemodialysis patients, and determine the differences in phosphate control between the two groups.
Methods: A total of 77 chronic hemodialysis patients were enrolled in this cross- sectional study from January 2012 to February 2012. Patient demographics, laboratory ?ndings, medication histories, and vascular calci?cation scores were collected. We divided the patients into anuric and nonanuric groups according to the residual renal function and then compared their clinical features. Multivariate binary regression analysis was used in each group to determine the independent factors related to phosphate control.
Results: The mean patient age was 59.27713.95 years, and 57.1% of patients were anuric. In anuric patients, dialysis vintage was signi?cantly longer, but the mean Kt/ V was not different between groups. Serum phosphate, ?broblast growth factor (FGF)-23, and Ca/P products were signi?cantly higher, and 1,25(OH)2D3 levels were signi?cantly lower in the anuric patients, although the intact parathyroid hormone and 25(OH)D levels were not different. In anuric patients, LnFGF-23 [hazard ratio (HR) 2.894, 95% con?dence interval (CI) 1.294?6.474, P¼0.010] was an independent factor predictive of phosphate control. However, in the nonanuric patients, glomerular ?ltration rate (HR 0.409, 95% CI 0.169?0.989, P¼0.047) and blood urea nitrogen (HR 1.090, 95% CI 1.014?1.172, P¼0.019) were independent factors predictive of phosphate control.
Conclusion: In chronic hemodialysis patients, preservation of residual renal function is a signi?cant determinant of phosphate control, and the factors associated with phosphate control is different depending on the residual renal function status.In the anuric patients, FGF-23 is most signi?cantly associated with phosphate control; however, glomerular ?ltration rate and blood urea nitrogen are more important than FGF-23 in the nonanuric HD patients.
& 2014.The Korean Society of Nephrology.Published by Elsevier. All rights reserved.
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KEYWORD
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End-stage renaldisease, Hemodialysis, Mineral metabolism, Phosphate control, Residualrenalfunction
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