PHOSPHATE REDUCTION AND AVOIDANCE OF ALUM INUM-CONTAINING PHOSPHATE BINDERS BY THE USE OF LARGE SURFACE DIALYZERS

Phosphate retention is a major cause of maintenance and aggravation of secondary hyperparathyroidism in hemodialysis patients. Therapeutic s trategies to reduce the hyperphosphatemia are dietary phosphate restri ction, the use of oral phosphate binders and a more effective dialysis . In a prospective study over 2 years we examined the effect of the us e of large surface dialyzers with better phosphate clearances on serum phosphate and the need for aluminium containing phosphate binders in 57 hemodialysis patients (age: 56.7 +/- 15.1 years, hemodialysis durat ion: 5.3 +/- 2.8 years) with hyperphosphatemia (34/57 patients with al uminium containing phosphate binders). The use of a large surface dial yzer (membrane area: 1.42 +/- 0.12 m(2) vs. 1.72 +/- 0.04 m(2), p < 0. 001) with better phosphate clearance (149 +/- 9 ml/min vs. 172 +/- 2 m l/min, p < 0.001) and the acceleration of the blood flow (214 +/- 19 m l/min vs. 242 +/- 20 ml/min, p < 0.001) led to a phosphate reduction o f 17.3% (7.9 +/- 2.4 mg/dl vs. 6.5 +/- 1.4 mg/dl) although the alumini um containing phosphate binders have been avoided in all patients. The dose of calcium containing phosphate binders and the concentration of serum albumin, aluminium and parathormone remained constant. Conclusi on: Hemodialysis with a large surface dialyzer is also an effective an d thus important therapeutic strategy to reduce hyperphosphatemia and to avoid aluminium containing phosphate binders and their complication s.