Importance of Phosphate Control for Restoration of Vascular Responsiveness in End‐Stage Renal Disease Patients Converted to Nocturnal Hemodialysis
Bibliographic record
Abstract
Hyperphosphatemia and poor uremia control are established cardiovascular risk factors in patients with end‐stage renal disease (ESRD) associated with impaired endothelial dependent and independent vasodilation (EDV and EIV). Nocturnal hemodialysis [6 × 8 h/week] augments dialysis dose and offers normal phosphate (Pi) balance. We hypothesized that NHD would restore EDV (endothelial function) and EIV (vascular smooth muscle cell function) by simultaneously improving uremia and Pi control. 2 groups of ESRD patients (mean age 41 ± 2 years) stratified according to their baseline plasma Pi levels (normal Pi <1.8 mM, high Pi >1.8 mM) were studied. Dialysis dose (Kt/V per session), plasma Pi, blood pressure (BP) and brachial artery responses to reactive hyperemia (EDV), and sublingual nitroglycerin (EIV) were examined before, 1 and 2 months after conversion from conventional hemodialysis (CHD) [3 × 4 h/week] to NHD. After 2 months, NHD increased dialysis dose (from 1.24 ± 0.06 to 2.04 ± 0.08; p = 0.02) and lowered BP (from 140 ± 5/82 ± 3 to 119 ± 1/71 ± 3, p = 0.01) in all patients. In patients with adequate Pi control during CHD, EDV was normalized after 1 month of NHD. In contrast, in the high Pi group, 1 month of NHD was sufficient to reduce plasma phosphate levels, but 2 months of NHD was required for EDV to improve. Variables Normal Pi (n=10) CHD NHD (1month) NHD (2months) High Pi (n=8) CHD NHD (1month) NHD (2 months) Pi (mM) −1.44 ± 0.09 1.08 ± 0.07 * 1.14 ± 0.11 * 2.52 ± 0.3 1.40 ± 0.17 * 1.26 ± 0.05 * EDV (%) −3.4 ± 2.7 7.5 ± 1.9 * 7.6 ± 1.3 * −1.7 ± 1.3 0.37 ± 1.6 † 8.8 ± 1.2 * EIV (%) −8.2 ± 4.8 10.3 ± 2.0 15.1 ± 2.0 * 5.1 ± 1.1 6.6 ± 0.8 † 16.9 ± 1.7 * p < 0.05 from values during CHD. p < 0.05 between the normal and high Pi groups. Correction of uremia without normalization of plasma Pi is insufficient to improve EDV. The time course over which this improvement in vascular responsiveness occurs is delayed in hyperphosphatemic patients, suggesting that improvement in endothelial and vascular smooth muscle cell function requires restoration of normal intracellular Pi balance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".