The sparsely studied matter of sulfate retention in end-stage renal disease was undertaken in recognition of the fact that the sorbent cartidge system of hemodialysis (SCD) does not remove sulfate as does the single pass system (SPD). The findings were as follows: (1) In nondialyzed patients, serum sulfate (Sso4) was positively correlated with serum cretinine (Scr); hypersulfatemia was generally present when the Scr exceeded 2 mg/100 ml. (2) In the dialysis patient, urinary volume and urinary sulfate excretion were positively correlated. (3) The sorbent cartridge did not adsorb sulfate from the dialysate to an appreciable degree. (4) In SPD patients, the Sso4 decreased from 2.60 to 0.89 mmoles/liter, a decrement of 66%. In contrast, in SCD patients receiving a comparable duration of hemodialysis, the Sso4 decreased from 3.62 to 2.87 mmoles/liter, a decrement of only 22%. (5) Twenty-nine home dialysis patients treated with SCD when seen in renal clinic had a mean Sso4 of 4.41 mmoles/liter compared to a Sso4 value of 2.07 mmoles/liter in 23 center dialysis patients (SPD) also seen in the renal clinic. The patients were otherwise comparable in terms of age, duration of dialysis. Scr, total CO2 and serum phosphorus. The alkaline phosphatase was significantly higher in home dialysis patients, (6) In previously undialyzed patients, the predialysis Sso4 increased over several weeks in some but not all the patients after the initiation of SCD; this rise did not occur in patients treated with SPD. The conclusion is made that sorbent cartridge hemodialysis promotes high serum sulfate levels in many dialysis patients, especially those with less residual renal function.
