Is there a serum phosphorus level you would consider too low to safely perform hemodialysis?
Answer from: at Academic Institution
I actually do. I have previously published reports of 2 patients who developed recurrent encephalopathy due to dialysis-induced hypophosphatemia. They were treated with adding phosphorus to the dialysis fluid and the episodes did not recur (Koganti & Sam, PMID 31940631). I definitely do not want...
Phosphate (P) removal on hemodialysis (HD) is dependent plasma P levels, the volume of blood passed through the dialyzer and the type vascular access used.
As HD removed by diffusion, as P is removed during HD the concentration gradient falls lessening the removal of P during the dialysis treatment...
There is no safe level as hd mainly removes intracellular phosphorus and low phosphorous level likely due to poor nutritional intake, assuming no binders.