Hypo phos and calcium

I found this article very interesting. I had to dialyse shorter (without Tinzaparin) with saline boluses every 30 mins. No problem unless you forget (I fly solo) So I shortened my sessions to 2 hrs, and increased to 6 days i.s.o. 4.5 days a week.

And suddenly my phosphate dropped to 0.7 (0.8-1.3 is normal I think)
So I'll reduce Renagel and see what happens

Am J Kidney Dis. 2017 Sep;70(3):445-448. doi: 10.1053/j.ajkd.2017.03.015. Epub 2017 May 9.
Fractures and Osteomalacia in a Patient Treated With Frequent Home Hemodialysis.

Hanudel MR1, Froch L2, Gales B3, Jüppner H4, Salusky IB3.
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Abstract

Bone deformities and fractures are common consequences of renal osteodystrophy in the dialysis population. Persistent hypophosphatemia may be observed with more frequent home hemodialysis regimens, but the specific effects on the skeleton are unknown. We present a patient with end-stage renal disease treated with frequent home hemodialysis who developed severe bone pain and multiple fractures, including a hip fracture and a tibia-fibula fracture complicated by nonunion, rendering her nonambulatory and wheelchair bound for more than a year. A bone biopsy revealed severe osteomalacia, likely secondary to chronic hypophosphatemia and hypocalcemia. Treatment changes included the addition of phosphate to the dialysate, a higher dialysate calcium concentration, and increased calcitriol dose. Several months later, the patient no longer required a wheelchair and was able to ambulate without pain. Repeat bone biopsy revealed marked improvements in bone mineralization and turnover parameters. Also, with increased dialysate phosphate and calcium concentrations, as well as increased calcitriol, circulating fibroblast growth factor 23 levels increased.
Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.