Hypophosphataemia in chronic kidney disease patients in haemodialysis

BACKGROUND: The presence of hypophosphataemia is increasing in specific clinical contexts such as alcoholism, sepsis, post-surgery and renal replacement therapies (RRT). However, the prevalence of hypophosphataemia in the literature is not clear and varies with the respective cut-off definition chosen. METHODS: We searched for relevant literature in Pubmed, Embase and Cochrane Library, with the following key words: hypophosphataemia, CKD and dialysis. MAIN BODY: Phosphate kinetics are much more complex than kinetics of other small molecules, such as urea or creatinine. Mean hourly phosphate removal in haemodiafiltration was highest during the first hour of the session. Studies shows that removal rate of phosphate was linearly dependent on respective plasma concentration. Dialysis technique, treatment duration, dialyser clearance and surface area are also relevant factors determining phosphate removal. CONCLUSION: Management of hypophosphataemia in dialysis patients is a hard challenge, and should be based on nutritional counselling and individualized dialytic treatments.