FP505EVALUATION OF PHOSPHOCALCIC PROFILE IN PATIENTS ON CHRONIC HEMODIALYSIS: COMPRATIVE STUDY BETWEEN HEMODIALYSIS BICARBONATE AND ACETATE FREE BIOFILTRATION AT 84‰

Abstract

Introduction and Aims: Disorders of phosphocalcic metabolism remain a daily problems of the patient on chronic hemodialysis, responsible for bone and cardiovascular complications. The aim of our study is to evaluate the change in phosphocalcic profile in both techniques: Hemodialysis bicarbonate (HDB) and acetate free biofiltration at 84‰(AFB 84‰). Methods: Prospective study, cross‐over, conducted in the research unit of the dialysis department of the Military Hospital of Tunis, over a period of 24 months, including 30 patients treated with HDB periodically, each patient had six successive sessions of HBD and 6 successive sessions of AFB at 84‰. 240;. A total of 357 sessions is performed, distributed in 180 sessions HDB and 177 sessions AFB at 84‰. 240;. The mean age of patients was 50 ± 14.5 years. The sex ratio was 1.14. The average length of hemodialysis was 44 ± 46.04 months. For the two techniques, we used a dialysate calcium concentration of 1.5 mmol / L, assays of serum calcium and phosphate at the beginning (T0) and end (T4) of the first and 4th sessions, as well as rates of parathyroid hormone (PTH) in predialysis (t0) of the first and the 6th sessions. Results: The analysis of results does not show any significant difference between the two techniques for serum calcium rate before and during the hemodialysis session, as has the cleaning of phosphorus. The difference was significant (p <0.05) for the post‐dialysis serum calcium (T4): 2.32 ± 0.25 mmol / L for HDB versus 2.43 ± 0.19 mmol / L AFB 84‰. 240;. A decrease in PTH rate was observed: 279.39 ± 222 ng / ml during the HDB versus 236.69 ± 213ng / ml AFB in 84‰. 240;. This decrease was significant (p = 0.013) in favor of the AFB at 84‰. 240;. Therefore, the best correction of metabolic acidosis in intracellular described for the AFB 84‰technique may be in question by acting on the ionized fraction of the calcium which increases with metabolic acidosis is subsequently cause of PTH secretion decline observed in our study. Conclusions: Comparing to the HDB, the AFB to 84‰, with its good correction of acid‐base balance, allowed for a better stabilization of phosphocalcic ratio and consequently a decrease in the stimulation of parathyroid glands ascertained by decrease significant PTH rate.