Phosphate equilibration rate and daily clearance in patients on CAPD, CCPD and APD.

BACKGROUND: Criteria for how to assess removal rate of inorganic phosphorous (iP) in peritoneal dialysis (PD) and whether iP removal differs between different PD modalities are debated.

METHODS: In a cross-sectional study, 73 prevalent patients on continuous ambulatory PD (n = 16), continuous cyclic PD (n = 8) or automated PD (n = 49) with mean age 54 (range, 18-87) years, 46 males, underwent standard peritoneal equilibration test (PET) and 24-hour collection of dialysate with measurements of iP, urea and creatinine in all samples and bags. There were 11 slow, 53 average, and 9 fast transporters.

RESULTS: D/P ratios for iP and creatinine at 4 h of PET were strongly correlated (ρ = 0.86, p<0.0001). Allocation of patients into slow, average and fast transporters according to D/P ratios for iP and creatinine was essentially similar. Whereas the weekly peritoneal clearance of iP (30.8 ± 16.6 L/wk) was lower than that of creatinine (38.4 ± 14.9 L/wk), clearances were strongly correlated (ρ = 0.89, p<0.0001). The correlation between peritoneal weekly clearance of iP and urea KT/V was however weak (ρ = 0.56, p<0.0001. CAPD patients had higher iP clearance than APD patients, 43.2 ± 14.9 versus 24.7 ± 13.4 L/wk (p<0.05); however, serum iP concentrations did not differ.

CONCLUSIONS: Creatinine is a good surrogate marker for phosphate removal, both as assessed by PET and by 24 hours' clearance, in different PD modalities. Therefore, a separate PET scale for phosphate may not be needed. iP removal was greater with CAPD than APD but serum phosphate levels did not differ.