scholarly journals Intradialytic Calcium Kinetics and Cardiovascular Disease in Chronic Hemodialysis Patients

2020 ◽  
Vol 49 (6) ◽  
pp. 723-732
Author(s):  
Markus Pirklbauer ◽  
Lisa Fuchs ◽  
Ramona Heiss ◽  
Thomas Ratschiller ◽  
Gert Mayer
Keyword(s):  
Cardiovascular Disease ◽  
Serum Calcium ◽  
Buffer Capacity ◽  
Ionized Calcium ◽  
Undercarboxylated Osteocalcin ◽  
Blood Calcium ◽  
Calcium Kinetics ◽  
Calcium Buffer ◽  
Potential Biomarker ◽  
The Mean

<b><i>Background/Objective:</i></b> Calcium loading has been associated with cardiovascular risk in hemodialysis (HD) patients. However, it remains to be elucidated whether alterations of intradialytic calcium buffering add to the increased cardiovascular disease burden in this high-risk population. <b><i>Methods:</i></b> Intradialytic calcium kinetics was evaluated in a cross-sectional observational study by measuring dialysate-sided ionized calcium mass balance (iCa<sub>MB</sub>), calcium buffer capacity, and change in serum calcium levels in 40 chronic HD patients during a routine HD session. A dialysate calcium of 3.5 mEq/L was used to adequately challenge calcium buffer mechanisms. Aortic pulse wave velocity and serum osteocalcin levels were measured prior to the HD session. Presence of cardiovascular disease and diabetes was assessed. <b><i>Results:</i></b> The mean dialysate-sided iCa<sub>MB</sub>, extracellular fluid ionized calcium mass gain, and buffered ionized calcium mass were 469 (±154), 111 (±49), and 358 (±145) mg/HD, respectively. The mean ionized serum calcium increase (∆iCa) was 0.42 (±0.14) mEq/L per HD. The mean intradialytic calcium buffer capacity was 73 (±18)%. Multivariate regression analysis revealed significant independent association of (1) iCa<sub>MB</sub> with the dialysate-to-blood calcium gradient at HD start and (2) intradialytic calcium buffer capacity with undercarboxylated osteocalcin. The presence of coronary heart disease was associated with higher ∆iCa but not iCa<sub>MB</sub> in the multivariate model. <b><i>Conclusions:</i></b> In line with our proof-of-concept study, we provide clinical evidence for a rapidly accessible and exchangeable calcium pool involved in intradialytic calcium regulation and for the role of osteocalcin as a potential biomarker. Our findings argue for evaluating the prognostic potential of intradialytic calcium kinetics in prospective clinical trials.

scholarly journals Hysteresis of the parathyroid hormone response to hypocalcemia in hemodialysis patients with low turnover aluminum bone disease.

1991 ◽  
Vol 2 (6) ◽  
pp. 1136-1143
Author(s):  
A J Felsenfeld ◽  
D Ross ◽  
M Rodriguez
Keyword(s):  
Parathyroid Hormone ◽  
Serum Calcium ◽  
Bone Disease ◽  
Calcium Concentration ◽  
Hemodialysis Patients ◽  
Ionized Calcium ◽  
Total Serum ◽  
High Calcium ◽  
The Mean ◽  
Pth Level

During the study of parathyroid function in 19 hemodialysis patients with low turnover aluminum bone disease, it was observed that serum parathyroid hormone (PTH) levels were higher during the induction of hypocalcemia than during the recovery from hypocalcemia. This type of PTH response has been termed hysteresis. Hypocalcemia was induced during hemodialysis with a calcium-free dialysate. When the total serum calcium level decreased to 7 mg/dL, the dialysate calcium concentration was changed to 3.5 mEq/L and the dialysis session was completed. One week later, hypercalcemia was induced during hemodialysis with a high-calcium dialysate. The mean basal PTH level was 132 +/- 37 pg/mL (normal, 10 to 65 pg/mL; immunoradiometric (IRMA), Nichols Institute, San Juan Capistrano, CA) and increased to a maximal PTH level of 387 +/- 91 pg/mL during hypocalcemia. For the same ionized calcium concentration, the PTH level was higher during the induction of hypocalcemia than during the recovery from hypocalcemia. Conversely, for the same ionized calcium concentration, the PTH level was greater when hypercalcemia was induced from the nadir of hypocalcemia than when hypercalcemia was induced from basal serum calcium. The set point of calcium (defined as the serum calcium concentration required to reduce maximal PTH by 50%) was greater during the induction of hypocalcemia than during the recovery from hypocalcemia (4.44 +/- 0.10 versus 4.25 +/- 0.09 mg/dL; P = 0.03). The mean basal ionized calcium concentration and the mean ionized calcium concentration at the intersection of the two PTH-calcium curves were the same (4.61 +/- 0.13 versus 4.61 +/- 0.12 mg/dL).(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Correlation between corrected serum calcium and serum albumin in children with idiopathic nephrotic syndrome in North central, Nigeria

2021 ◽  
Vol 8 (2) ◽  
pp. 207
Author(s):  
Ozohu A. Aliyu ◽  
Shamsudeen Mohammed ◽  
Yakubu Abdullahi
Keyword(s):  
Nephrotic Syndrome ◽  
Serum Albumin ◽  
Serum Calcium ◽  
Idiopathic Nephrotic Syndrome ◽  
Ionized Calcium ◽  
Total Serum ◽  
Healthy Children ◽  
Positive Correlation ◽  
Total Serum Calcium ◽  
The Mean

Background: Nephrotic syndrome is a clinical condition caused by alteration of glomerular membrane permeability resulting in a net loss of protein, and vitamin D binding proteins in urine leading to hypoalbuminaemia and hypocalcaemia. A positive correlation between serum albumin and ionized calcium in childhood nephrotic syndrome has been described but the correlation between total serum calcium or corrected serum calcium and serum albumin has not been extensively described.Methods: This study was carried out at Dalhatu Araf Specialist Hospital, Lafia Nigeria. Fifteen children with idiopathic nephrotic syndrome were recruited consecutively as the cases, 15 age and gender matched healthy children were recruited as the controls. Total serum calcium and albumin was assayed in all these children. Corrected serum calcium was calculated for the cases. Tests of correlation was carried out to see if there was any relationship between corrected or total serum calcium and serum albumin.Results: The mean total serum calcium and serum corrected calcium levels in the cases was 2.04±0.34 mmol/l and 2.5 mmol/l respectively. The mean total serum calcium was 2.12±0.32 mmol/l for the controls. The mean serum albumin level was 14.7±4.1 g/l and 34.6±2.7 mmol/l for the cases and controls respectively. A negative and weak correlation was found between serum albumin and corrected serum calcium and a similar negative correlation between serum albumin and total serum calcium.Conclusions: The common reports of a positive correlation between serum ionized calcium and serum albumin cannot be applied to total or corrected serum calcium and serum albumin.

CLINICAL AND PARACLINICAL CHARACTERISTITICS OF ROTAVIRUS DIARRHEA IN CHILDREN LESS THAN 5 YEARS OLD IN PEDIATRIC DEPARTMENT OF BINH DINH GENERAL HOSPITAL

2013 ◽  
pp. 50-56
Author(s):  
Quoc Tinh Nguyen ◽  
Thi Cu Nguyen
Keyword(s):  
General Hospital ◽  
Acute Diarrhea ◽  
White Blood Cells ◽  
Blood Calcium ◽  
Pediatric Department ◽  
Rotavirus A ◽  
Initial Symptoms ◽  
Stool Specimens ◽  
The Mean ◽  
Rotavirus Diarrhea

Background: Diarrhea is a leading cause of morbidity and mortality in children in developing countries. Rotavirus is the most important factor cause of severe diarrhea and mortality in children, especially under 2 years. Objective: To study Clinical and paraclinical characteristitics of rotavirus diarrhea in children less than 5 years old in the Pediatric Department of Binh Dinh General Hospital. Methods: Cross observational study, 417 children from 2 months to 5 years old who were hospitalized for acute diarrhea without blood in stool in Pediatric Department of Binh Dinh general hospital, from 15/3/2012 to 14/3/2013. There were 228 patients with rotavirus - positive stool specimens and 189 patients with rotavirus - negative stool specimens. Tested for rotavirus A classification by agglutination techniques. Results: Percentage of Rotavirus diarrhea in children <5 years was 54.7%. The mean age of rotavirus diarrhea was 14.83 ± 9.08 tháng months. Ages with the highest cases of rotavirus diarrhea are 2 - 12 months: 48.2%. Rotavirrus diarrhea is experienced in every month but, the highest prevalence is experienced in the spring - summer) with 71,5%. Clinical characteristitics of rotavirus diarrhea: Vomit presents in 91,7% of cases. 32.9% of the initial symptoms of the disease is vomiting. Mean number of vomiting episodes per day: 7 ± 3.57 times, significantly higher compared with non-rotavirus acute diarrhea (p <0,01). Mean number of bowel movement per day: 10.61±4.18 times, mean duration of diarrhea: 6.66 ± 2.52 days. Younger children have higher frequency and duration of diarrhea compared to older children. Paraclinical characteristitics of rotavirus diarrhea: the mean number leukocyte: 9.74 ±3.61 (x 109/l). 2.2% with low blood sodium status; 8.8% with reduction in serum potassium concentration. 26.3% with low blood calcium and glucose status. Laboratory characteristics of stool: 8.8% with white blood cells in stool, 41.7% with carbohydrate in stool. Conclusion: Rotavirus accounting for 54.7% of the causes of diarrhea in children. Rotavirus diarrhea is experienced throughout the year but the highest prevalence is in the spring-summer. Prominent symptoms of the disease are vomiting and watery stool. Children <24 months experience higher frequency and duration of diarrhea compared to older age groups. Key words: Diarrhea, Rotavirus.

Mycobacterial infection influences bone biomarker levels in patients with Crohn’s disease

2018 ◽  
Vol 96 (7) ◽  
pp. 662-667 ◽  
Author(s):  
Amna Naser ◽  
Ahmad Qasem ◽  
Saleh A. Naser
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Mycobacterium Avium ◽  
Disease Model ◽  
Mycobacterial Infection ◽  
Undercarboxylated Osteocalcin ◽  
Healthy Cattle ◽  
The Mean ◽  
Mycobacterium Avium Subsp Paratuberculosis ◽  
Active Inflammation

Patients with Crohn’s disease (CD) have higher risk for osteoporosis following decreased level of osteocalcin. We hypothesize that active inflammation following Mycobacterium avium subsp. paratuberculosis (MAP) infection results in elevation of undercarboxylated osteocalcin (ucOC) and downregulation of active osteocalcin in CD patients and cow-disease model (Johne’s disease). In this study, we measured ucOC, active osteocalcin, and calcium levels in sera from 42 cattle (21 infected with MAP and 21 healthy cattle), 18 CD patients, and 20 controls. The level of ucOC in MAP+ bovine samples was higher than that in MAP− controls (318 ± 57.2 nmol/mL vs. 289 ± 95.8 nmol/mL, P > 0.05). Consequently, mean calcium level in bovine MAP+ was significantly higher than that in bovine-MAP− samples (9.98 ± 0.998 mg/dL vs. 7.65 ± 2.12 mg/dL, P < 0.05). Also, the level of ucOC was higher in CD-MAP+ than in CD-MAP− (561 ± 23.7 nmol/mL vs. 285 ± 19.6 nmol/mL, P < 0.05). Interestingly, the mean osteocalcin level in MAP+ bovine was lower than that in MAP− bovine (797 ± 162 pg/mL vs. 1190 ± 43 pg/mL) and it was lower in CD-MAP+ than in CD-MAP− infection (1.89 ± 0.184 ng/mL vs. 2.19 ± 0.763 ng/mL) (P < 0.05). The correlation between MAP infection and elevation of sera ucOC, reduction of active osteocalcin and increased calcium supports MAP infection role in CD and complications with osteoporosis.

Calculated serum calcium is an insufficient surrogate for measured ionized calcium

2009 ◽  
Vol 49 (3) ◽  
pp. 348-350 ◽  
Author(s):  
Mikko P. Björkman ◽  
Antti J. Sorva ◽  
Reijo S. Tilvis
Keyword(s):  
Serum Calcium ◽  
Ionized Calcium

scholarly journals Association of dietary calcium intake, total and ionized serum calcium levels with preeclampsia in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rahel D. Gebreyohannes ◽  
Ahmed Abdella ◽  
Wondimu Ayele ◽  
Ahizechukwu C. Eke
Keyword(s):  
Serum Calcium ◽  
Calcium Intake ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Dietary Calcium ◽  
Ionized Calcium ◽  
Dietary Calcium Intake ◽  
Total Serum ◽  
Total Serum Calcium ◽  
Total Serum Calcium Level

Abstract Background Preeclampsia is a well-known cause of maternal mortality and morbidity in Ethiopia. The exact pathophysiology has not been fully understood. Calcium and magnesium deficiencies have been given emphasis to play roles in the pathophysiology. Although evidence is abundant, they are equivocal. The study aimed to see the association of dietary calcium intake, serum total calcium level and ionized calcium level with preeclampsia. It also evaluated the association between dietary calcium intake and serum calcium levels. Materials and methods An unmatched case–control study was conducted in Gandhi Memorial, Tikur Anbessa, and Zewditu Memorial Hospitals, all in Addis Ababa, between October to December, 2019. Cases were 42 women with preeclampsia and controls were 42 normotensive women. The medical and obstetric history was gathered using a structured questionnaire and the dietary calcium intake information using a 24-h dietary recall. The serum levels of total serum calcium and ionized (free) calcium were measured using an inductively coupled mass spectrophotometer. Bivariate and multivariate logistic regression and Pearson correlation test were utilized during data analysis. Results In comparison with controls, women with preeclampsia had lower mean (± 1SD) levels of ionized calcium level (1.1 mmol/l ± 0.11), total serum calcium level (1.99 mmol/l ± 0.35) and lower median (IQR) dietary calcium intake (704 mg/24 h,458–1183). The odds of having preeclampsia was almost eight times greater in those participants with low serum ionized calcium level (OR 7.5, 95% CI 2.388–23.608) and three times higher in those with low total serum calcium level (OR 3.0, 95% CI 1.024–9.370). Low dietary calcium intake also showed statistically significant association with preeclampsia (OR 3.4, 95% CI 1.092 -10.723). Serum ionized calcium level and total serum calcium level showed positive correlation of moderate strength (p = 0.004, r = 0.307), but no correlation was found between dietary calcium intake with both forms of serum calcium levels. Conclusion This study showed significant association between low dietary calcium intake and low serum calcium levels with preeclampsia, hence this can be used as a supportive local evidence for the current context-specific recommendation of calcium supplementation in societies with low-dietary calcium consumption in an attempt to prevent preeclampsia, therefore implementation study should be considered in Ethiopia to look for the feasibility of routine supplementation.

Effect of Hypocalcemia on Cardiac Function in Very-Low-Birth-Weight Preterm Neonates: Studies of Blood Ionized Calcium, Echocardiography, and Cardiac Effect of Intravenous Calcium Therapy

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 543-550
Author(s):  
Pankaja S. Venkataraman ◽  
Don A. Wilson ◽  
Roger E. Sheldon ◽  
Radhakrishna Rao ◽  
Michael K. Parker
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cardiac Function ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Very Low Birth Weight ◽  
Left Ventricular ◽  
Ionized Calcium ◽  
Total Calcium ◽  
Serum Total Calcium

Traditionally, in infants, a serum calcium value less than 7.0 mg/dL is considered to impair cardiac function. In very-low-birth-weight infants, we studied the hypotheses that decline in serum calcium to 6.0 mg/dL (1) would not impair cardiac function and (2) ionized calcium would remain greater than 3.0 mg/dL. We also evaluated the effect of calcium infusion on cardiac function. We studied 15 normokalemic and normonatremic infants whose birth weights were 822 to 1,450 g and were less than 32 weeks' gestation. When serum calcium declined to less than 6.0 mg/dL, 18 mg/kg of calcium as 5% calcium gluconate was infused for 10 minutes. Serum total calcium concentration, blood ionized calcium concentration, ECG, and M-mode echocardiogram were obtained on entry into the study, when the infants were hypocalcemic, immediately after treatment with calcium, and eight hours after treatment. Ionized calcium values were calculated based on serum total calcium and serum protein, and corrected calcium values were calculated based on serum total calcium, serum albumin, and blood pH. In all infants, serum calcium value declined to less than 7.0 and in eight infants to less than 6.0 mg/dL. Assessment of heart rate, systolic blood pressure, ejection fraction, left ventricular systolic time interval, right ventricular systolic time interval, fiber shortening index, and left ventricular mean velocity of circumferential fiber shortening showed no significant alteration from baseline during hypocalcemia or in association with intravenous slow bolus infusion of 18 mg/kg of calcium. In association with a decline in serum total calcium to as low as 6.0 mg/dL, whole blood ionized calcium was maintained at more than 3.0 mg/dL. Serum total calcium and calculated ionized calcium values correlated significantly with measured blood ionized calcium concentrations; however, these measures were not reliable predictors of blood ionized calcium. We speculate that the hypoproteinemia and hypoalbuminemia noted in these infants may result in relative protection of the blood ionized calcium in these infants. We suggest that in neonates with wide ranges in gestation, serum protein, and blood pH levels, total serum calcium and calculated ionized calcium values may be poor measures of derangement of calcium metabolism. Decline in total serum calcium concentration to 6.0 mg/dL was not associated with impaired cardiac function, and slow bolus calcium infusion in these hypocalcemic very-low-birth-weight infants neither improved nor impaired cardiac function.

An Assessment of Serum Cholesterol level and BMI in Women: Study in Several Private Chambers in Mymensingh

2019 ◽  
Vol 8 (2) ◽  
pp. 4-9
Author(s):  
Nahid Bintay Ansary ◽  
Arup Ratan Paul ◽  
Md Mahamudur Rahman ◽  
Maria Hussain ◽  
Rubiat Naznin
Keyword(s):  
Cardiovascular Disease ◽  
Health Status ◽  
Cholesterol Level ◽  
Serum Cholesterol ◽  
Serum Cholesterol Level ◽  
Normal Weight ◽  
Cholesterol Levels ◽  
Increased Risk ◽  
The Mean ◽  
Study Participants

The increased risk of cardiovascular disease associated with higher serum cholesterol levels in middle-aged persons has been established, but there have been few studies conducted regarding the issues in Mymensingh. For evaluation of serum cholesterol and BMI in women of Mymensingh, across-sectional studywas conducted in several private chambers in the districts of Mymensingh, Bangladesh during the period from January 2017 to December 2017. A total of 48 Female patients participated in the study. In the study, participants were aged between 18 to 29 years of age. The study suggested that the serum cholesterol was below 4.99 were 15(31.25%), 5.00 to 6.49 were 13(26.08%) and above 6.50 were 20 (41.67%), the Mean ± SD was 4.45 (0.76). The health status according to BMI showed that 12.50% (n=6) of the participants were underweight <18.49, majority 50.00% (n=24) of the population were from normal weight range (18.5-24.9), 16.67% (n=8) of the participants were overweight and 20.83 %( n=10) of the participants were obese >30. The Mean ± SD was 18.93± (3.68). Measurement of BMI and Serum Cholesterol levels can help doctors to treat patients properly for reducing the burden of death in our country. CBMJ 2019 July: Vol. 08 No. 02 P: 4-9

scholarly journals Metabolic evaluation of Crioulo horses participating in competitions of 750 km

2013 ◽  
Vol 33 (12) ◽  
pp. 1471-1477 ◽  
Author(s):  
Lorena Alvariza Amaral ◽  
Millie Marchiori ◽  
Charles Ferreira Martins ◽  
Marcio Nunes Correa ◽  
Carlos Eduardo Wayne Nogueira
Keyword(s):  
Inflammatory Process ◽  
Ionized Calcium ◽  
Metabolic Responses ◽  
Total Calcium ◽  
Blood Cell Count ◽  
Metabolic Evaluation ◽  
Sodium Potassium ◽  
Blood Samples ◽  
Mean Values ◽  
The Mean

The Crioulo breed of horses performs in one of the most physically demanding equestrian competitions, the Marcha de Resistência, which is a contest in which the horses run 750 km in 15 days. The study's aim was to characterize the metabolic responses during this period. We evaluated eleven Crioulo horses in the competition, specifically, two males and nine females. Blood samples were collected 24 hours before the contest and on the 4th, 9th, 11th, 14th and 15th days of competition. We evaluated CK, AST, LDH, glucose, lactate, urea, creatinine, sodium, potassium, chloride, magnesium, total calcium, ionized calcium, total protein, hematocrit and the white blood cell count. At the end of the competition, the mean values of serum AST were 1151±358 IU/ L the mean LDH values were 7418±1695 IU/L and CK was 13,867±3998UI /L. There was a significant increase in urea, creatinine and lactate (p<0.0001). A decrease in the mean values of chloride, sodium, potassium, and total and ionized calcium was observed (p≤0.0002). An evaluation of the total leukocytes and segmented neutrophils (p≤0.0002) revealed their increased values, and decreased values were observed for hematocrit, plasma protein and total lymphocytes (p≤0.0003). The values of glucose, on average, remained constant. Based on these data, we conclude that the Marcha de Resistência competition necessitated a high muscular demand and the depletion of energy and electrolytes, suggesting an inflammatory process in the animals evaluated.

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