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American Journal of Kidney Diseases

Phosphate Kinetic Models in Hemodialysis: A Systematic Review

  • Sisse H. Laursen
    Correspondence
    Address for Correspondence: Sisse H. Laursen, MSc, Department of Health Science and Technology, University of Aalborg (AAU), Fredrik Bajers Vej 7C1, 9220 Aalborg, Denmark.
    Affiliations
    The Danish Diabetes Academy, Odense University Hospital, Odense, Denmark

    Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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  • Peter Vestergaard
    Affiliations
    Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Department of Endocrinology, Aalborg University, Aalborg, Denmark
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  • Ole K. Hejlesen
    Affiliations
    Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Published:November 27, 2017DOI:https://doi.org/10.1053/j.ajkd.2017.07.016

      Background

      Understanding phosphate kinetics in dialysis patients is important for the prevention of hyperphosphatemia and related complications. One approach to gain new insights into phosphate behavior is physiologic modeling. Various models that describe and quantify intra- and/or interdialytic phosphate kinetics have been proposed, but there is a dearth of comprehensive comparisons of the available models. The objective of this analysis was to provide a systematic review of existing published models of phosphate metabolism in the setting of maintenance hemodialysis therapy.

      Study Design

      Systematic review.

      Setting & Population

      Hemodialysis patients.

      Selection Criteria for Studies

      Studies published in peer-reviewed journals in English about phosphate kinetic modeling in the setting of hemodialysis therapy.

      Predictor

      Modeling equations from specific reviewed studies.

      Outcomes

      Changes in plasma phosphate or serum phosphate concentrations.

      Results

      Of 1,964 nonduplicate studies evaluated, 11 were included, comprising 9 different phosphate models with 1-, 2-, 3-, or 4-compartment assumptions. Between 2 and 11 model parameters were included in the models studied. Quality scores of the studies using the Newcastle-Ottawa Scale ranged from 2 to 11 (scale, 0-14). 2 studies were considered low quality, 6 were considered medium quality, and 3 were considered high quality.

      Limitations

      Only English-language studies were included.

      Conclusions

      Many parameters known to influence phosphate balance are not included in existing phosphate models that do not fully reflect the physiology of phosphate metabolism in the setting of hemodialysis. Moreover, models have not been sufficiently validated for their use as a tool to simulate phosphate kinetics in hemodialysis therapy.

      Index Words

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