Modification And Validation Of The Phosphate Removal Model: A Multicenter Study

Background: Our research group has previously reported a noninvasive model that estimates phosphate removal within a 4-h hemodialysis (HD) treatment. The aim of this study was to modify the original model and validate the accuracy of the new model of phosphate removal for HD and hemodiafiltration (HDF) treatment. Methods: A total of 109 HD patients from 3 HD centers were enrolled. The actual phosphate removal amount was calculated using the area under the dialysate phosphate concentration time curve. Model modification was executed using second-order multivariable polynomial regression analysis to obtain a new parameter for dialyzer phosphate clearance. Bias, precision, and accuracy were measured in the internal and external validation to determine the performance of the modified model. Results: Mean age of the enrolled patients was 63 +/- 12 years, and 67 (61.5%) were male. Phosphate removal was 19.06 +/- 8.12 mmol and 17.38 +/- 6.75 mmol in 4-h HD and HDF treatments, respectively, with no significant difference. The modified phosphate removal model was expressed as Tpo(4) = 80.3 x C-45 - 0.024 x age + 0.07 x weight + beta x clearance - 8.14 (beta = 6.231 x 10(-3) x clearance - 1.886 x 10(-5) x clearance(2) - 0.467), where C-45 was the phosphate concentration in the spent dialysate measured at the 45th minute of HD and clearance was the phosphate clearance of the dialyzer. Internal validation indicated that the new model was superior to the original model with a significantly smaller bias and higher accuracy. External validation showed that R-2, bias, and accuracy were not significantly different than those of internal validation. Conclusions: A new model was generated to quantify phosphate removal by 4-h HD and HDF with a dialyzer surface area of 1.3-1.8 m(2). This modified model would contribute to the evaluation of phosphate balance and individualized therapy of hyperphosphatemia.