Dr Rachel Frederick1, Dr Nicole Lioufas2,3,4,5,6
1Department of General Medicine, St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2Department of Nephrology, Western Health, St Albans, Australia, 3Department of General Medicine, Western Health, St Albans, Australia, 4Department of Nephrology, Royal Melbourne Hospital, Parkville, Australia, 5Department of General Medicine, Royal Melbourne Hospital, Parkville, Australia, 6University of Melbourne, Melbourne, Australia
Background: Hyperphosphataemia has been associated with increased mortality and cardiovascular events in CKD. Complicating phosphate management are the following issues; 1) the accuracy of serum phosphate given diurnal phosphate variability has been observed in the general population and haemodialysis patients, with unclear clinical impact upon phosphate binder prescription. 2) the impact of pill burden, maintaining a phosphate binder prescription without high exogenous calcium administration.
Aim: To review our current management of hyperphosphataemia in patients on haemodialysis; analysing time of measurement of mineral metabolites and impact on phosphate binder prescription.
Methods: Retrospective cohort study of patients on satellite haemodialysis at Western Health between December 2021 to March 2022. We collated baseline demographics, mineral metabolites and phosphate binder details on patients in either morning or afternoon sessions of haemodialysis. Exclusion criteria involved patients being managed by a private nephrologist due to insufficient data, or if on twilight dialysis.
Results: We reviewed 162 patients with 105 patients eligible for assessment. Mean age was 65 ± 13 years, 69% male, 46% with known ischaemic heart disease, 73% diabetic. 88% of patients were prescribed phosphate binders. These included calcium carbonate (45%), lanthanum carbonate (32%), sevelamer (35%), aluminium (1%), sucroferric oxyhydroxide (3%), with median 6 phosphate binder units (IQR3-8). Mean serum phosphate was 1.90 ± 0.67mmol/L, with 33% of patients within normal range. Neither mean serum phosphate or phosphate binder prescription were different between morning and afternoon shifts.
Conclusion: Phosphate management comprises a high volume of pill burden with exogenous calcium administration comprising 45% of binders prescribed at our institution. Phosphate variability between timing of phosphate measurements did not result in a clinically significant difference in our cohort of patients.
Biography:
Bio to come