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Simposio Fosforo e MBD in PD: vecchi e nuovi protagonisti

Simposio Fosforo e MBD in PD: vecchi e nuovi protagonisti Rimozione del fosforo e dialisi peritoneale Roberto Russo. Hyperphosphatemia is a predictor of overall and CV mortality. Noordzij M et al NDT 21: 2513–2520,2006. Serum Phosphorus and Mortality in

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Simposio Fosforo e MBD in PD: vecchi e nuovi protagonisti

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  1. Simposio Fosforo e MBD in PD: vecchi e nuovi protagonisti Rimozione del fosforo e dialisi peritoneale Roberto Russo

  2. Hyperphosphatemiais a predictorofoverall and CV mortality Noordzij M et al NDT 21: 2513–2520,2006

  3. Serum Phosphorus and Mortality in Dialysis Patients Ansell D et al NDT 22: 667, 2007

  4. Serum Phosphorus and Mortality in PD Patients Data on 7034 PD patientswhoattended Da Vita dialysisclinics for at least 3 months Mehrotraet al Perit Dial Int 27: Suppl 3, S12, 2007

  5. Percentageachievementof the K/DOQI guidelineforbonemetabolism 40% Calcium Phosph CaxP iPTH Noordzij M et al NDT 21: 2513–2520,2006

  6. Management ofhyperphosphatemia in PD patients • Dietaryphosphaterestriction • Removalofphosphatebydialysis and residualrenalfunction • Administrationofphosphatebinder

  7. Total body phosphate 700 g

  8. Phosphatebalance in dialyzedpatients Ketteler M, GrossML, Ritz E. KidneyInt 2005;67:s120-7

  9. Sedlacek M et al Am J Kidney Diseases 2000; 36: 1020-1024

  10. Bammens B et al Am J Kidney Dis 2005; 46: pp 512-519

  11. Superior dialytic clearance of |[beta] |2-microglobulin and p-cresol by high-flux hemodialysis as compared to peritoneal dialysis Phosphateclearance • 55 L/1.73 m2 in APD 34 patients • 66 L/1.73 m2 in CAPD 16 patients Enevepoel P et al KidneyInt 2006; 70:794-9

  12. Is it possible to control hyperphosphataemiawith diet? Serum P 5.5 mg/dl PCl 57L/week 5,5 mg/dl x 57 L / sett = 3135 mg of P - 3135/7 = 447 mg 60-64 g proteine x 14-15 mg (contenuto di P x g proteine) = 960 mg/2 = 480 mg Rufino M et al NephrolDialTransplant 1998; 13(Suppl 3): 65–67

  13. Urinaryphosphateexcretion • CAPD patientsurinaryexcretion (48.8+21.4) representabout 40% of the total Pi removed • Urinary Pi excretionwaslinearlyrelatedto GFR values Messa P et al NephrolDialTransplant 1998; 13 (Suppl 6): 43–48

  14. ResidualRenalFunction and PhosphateLevels • Only 29% ofpatientswithpreserved RRF had a serumphosphateconcentration > 5.6 mg/dl ascomparedwith 44% of the anuricpatients • Residual GFR wasanimportantpredictorofserumphosphatelevels in a cross sectionalstudyofover 250 prevalent PD patients Wang AYM et al Amer J Kidney Dis 2004; 43: 712-720

  15. Urinaryphosphateexcretion Bammens B et al Amer J Kidney Dis 2005; 46: 512-519

  16. WithRRF Cumulative Survival No RRF Follow-up months Sopravvivenza dei pazienti in dialisi peritoneale Wang AYM, NephrolDialTransplant 2005

  17. Phosphatecontrolwithnocturnal HD CHD NHD Mucsi I et al KidneyInt 1998

  18. Phosphatecontrolwithnocturnal HD Lindsay RM et al Amer J Kidney Dise 2003; 42: (Suppl 1) S24-S29

  19. D/P RatioofSolutes in PD 1,0 UREA 0,9 CREATININE 0,7 PHOSPHATE D/P 0,4 8 2 4 Tempo di stazionamento (ore)

  20. Transperitonealphosphatetransport • Convention • Diffusion down anelectrochemicalgradient • Lymphaticconvectiveabsorptionisnot a factor Graff J et al ClinPhysiol 1996; 16:291-300

  21. Phosphateremoval on PD 66 mg 111 mg mg P < 0.001 Delmez JA et al Kidney Int 1982; 21: 862—867

  22. Predictorsofphosphateremoval Messa P et al NephrolDialTransplant 1998; 13 (Suppl 6): 43–48

  23. Associationbetween 24-hour UF and percentofphosphateremovedby UF Granja CA et al ContribNephrol 2009; 163:198-205

  24. PhosphateBalance in PeritonealDialysis: RoleofUltrafiltration Granja CA et al ContribNephrol 2009; 163:198-205

  25. Phosphateclearanceaccordingtoperitoneal membrane transportcharacteristic Sedlacek M et al Am J Kidney Diseases 2000; 36: 1020-1024

  26. Phosphateclearanceaccordingtoperitoneal membrane transportcharacteristic Badve SV et al Clin J Am Soc Nephrol 2008; 3: 1711–1717

  27. Relation between the D/P ratios and clearanceofphosphorus and creatinine Sedlacek M et al Am J Kidney Diseases 2000; 36: 1020-1024

  28. Determinantsofperitonealphosphateclearance, bylinearregression Badve SV Clin J Am Soc Nephrol 2008; 3: 1711–1717

  29. Phosphateclearanceaccordingtoperitoneal membrane transportcharacteristic PeritonealPhosphateClearance Badve SV Clin J Am Soc Nephrol 2008; 3: 1711–1717

  30. Phosphateclearanceaccordingtoperitoneal membrane transportcharacteristic IPD 15x2 totale 30 L - TPD (50%) 29x1 totale 30 L Piraino B et al PeritDialInt 1994; 14:145-148

  31. PeritonealPhosphateclearancesaccordingto PD modality *CCPD2 * Liters/week

  32. The impact ofvarious NIPD cycling regimens on phosphorusremoval in chronic PD patients L/1.73 m2 14 L 24 L 24 L Juergensens P et al Int J ArtifOrgans 2005;28:1219-23

  33. A comparisonofclearances on tidalperitonealdialysis and intermittentperitonealdialysis IPD 15x2 totale 30 L - TPD (50%) 29x1 totale 30 L Piraino B et al PeritDialInt 1994; 14:145-148

  34. Adequacyofautomatedperitonealdialysiswith and withoutmanual daytime exchange: a randomizedcontrolled trial P = 0.68 Dailyphosphateclearance L/1.73 m2 Demetriou D et al KidneyInt 2006; 70:1649-55

  35. Conclusions 1 • Total phosphateclearancedepends on both RRF and peritonealclearance and mayfallsubstantiallyas RRF declines • Phosphateclearances are limitedwith PD therapy • Phosphateclearance on NIPD isinferiortothat on CAPD becauseoftimedependentremovalofphosphate • High flow CCPD may produce a marginalincrease in peritonealphosphateclearance • CCPD and CCPD2 do notappeartohave major differences

  36. Conclusions 2 • Thereis a realconcernthatwithreduction in K/DOQI guidelinesto KT/V 1.7, phosphateremovalwith PD willbefurthercompromised • Topreventhyperphosphatemiamostpatientsundergoing PD requireanexogenusphosphatebinder

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