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REVIEW  CONSERVATIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE: HOW TO AVOID OR DEFER DIALYSIS 

Panminerva Medica 2017 June;59(2):133-8

DOI: 10.23736/S0031-0808.16.03283-3

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Clinical benefits of phosphate control in progression of end stage renal disease

Piergiorgio BOLASCO, Stefano MURTAS

Territorial Nephrology and Dialysis Unit, ASL Cagliari, Cagliari, Italy


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It is largely agreed that preservation of residual kidney function (RKF) has a directly proportional affect on general, and in particular cardiovascular, mortality. During evaluation of patients on infrequent hemodialysis (ID) as both as once-weekly or twice-weekly hemodialysis it has been frequently underestimated the importance of phosphaturia, Indeed, the native kidney preserves the ability to eliminate not only toxic molecules but also a significative output of phosphate despite of a severe decrease of RKF. This task the modern membranes are as yet not very efficient of reproducing. The hemodialysis patients on ID who adhere accurately to a low protein diet of 0.6-0.8 g/kg/day could reach a draw in the balance of phosphates. In view of the significant impact produced by poor phosphate control on both RKF and the frequency of even severe cardiovascular effects, infrequent dialysis with its negative or neutral weekly phosphate balance, may constitute a valid “bridging” treatment even in the long-term, thus explaining the improved survival rates compared to patients receiving conventional triweekly hemodialysis.


KEY WORDS: Renal dialysis - Hypophosphatemia, familial - Kidney function tests

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