scholarly journals Skeletal and cardiovascular consequences of a positive calcium balance during hemodialysis

2020 ◽  
Author(s):  
Rosilene M. Elias ◽  
Sharon Moe ◽  
Rosa M. A Moysés
Keyword(s):  
Mass Transfer ◽  
Vascular Calcification ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Myocardial Dysfunction ◽  
Organ Damage ◽  
Calcium Balance ◽  
Direct Effects ◽  
Dialysate Calcium ◽  
Existing Data

Abstract Patients on hemodialysis are exposed to calcium via the dialysate at least three times a week. Changes in serum calcium vary according to calcium mass transfer during dialysis, which is dependent on the gradient between serum and dialysate calcium concentration (d[Ca]) and the skeleton turnover status that alters the ability of bone to incorporate calcium. Although underappreciated, the d[Ca] can potentially cause positive calcium balance that leads to systemic organ damage, including associations with mortality, myocardial dysfunction, hemodynamic tolerability, vascular calcification, and arrhythmias. The pathophysiology of these adverse effects includes serum calcium changes, parathyroid hormone suppression, and vascular calcification through indirect and direct effects. Some organs are more susceptible to alterations in calcium homeostasis. In this review, we discuss the existing data and potential mechanisms linking the d[Ca] to calcium balance with consequent dysfunction of the skeleton, myocardium, and arteries.

The Influence of Dialysate Calcium Concentration on the Pth Level in Children Undergoing Capd

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 567-569 ◽  
Author(s):  
Maria Sieniawska ◽  
Maria Roszkowska-Blaim ◽  
Beata Wojciechowska
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Dwell Time ◽  
Calcium Concentration ◽  
Vitamin D Metabolites ◽  
Intact Parathyroid Hormone ◽  
Gland Function ◽  
Dialysate Calcium ◽  
Pth Level

In 12 children aged four-and-a-half to 18 years (mean 11 ±4.2) undergoing continuous ambulatory peritoneal dialysis (CAPO), serum intact parathyroid hormone (iPTH), ionized calcium (iCa) levels, and calcium mass transfer (CaMT) were measured on three consecutive days: day 1, after a four-hour interval between dialyses; on day 2, after four hours dwell time with peritoneal dialysis (PD) Ca 3.5 mEq/L; and on day 3, after four hours dwell time with PD Ca 2.5 mEq/L. A significantly more negative CaMT was found when PD Ca 2.5 mEq/L was used, as compared with values obtained using PD Ca 3.5 mEq/L. Significantly lower parathyroid hormone (PTH) values were found after the interval between exchanges. We conclude that in order to properly evaluate parathyroid gland function and to decide whether or not to give vitamin D metabolites, a protocol for determining PTH should be standardized.

Individualization of Dialysate Calcium Concentration According to Baseline Pre-Dialysis Serum Calcium

2014 ◽  
Vol 38 (3-4) ◽  
pp. 224-233 ◽  
Author(s):  
Emilio Gonzalez-Parra ◽  
Maria Luisa Gonzalez-Casaus ◽  
Maria Dolores Arenas ◽  
Valeria Sainz-Prestel ◽  
Liliana Gonzalez-Espinoza ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Calcium Concentration ◽  
Dialysate Calcium

Effects of Lowering Dialysate Calcium Concentration on Carotid Intima-Media Thickness and Aortic Stiffness in Patients Undergoing Maintenance Hemodialysis: A Prospective Study

2016 ◽  
Vol 42 (4) ◽  
pp. 337-346 ◽  
Author(s):  
Zhangxiu He ◽  
Lei Cui ◽  
Chunyuan Ma ◽  
Hong Yan ◽  
Tanyong Ma ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Calcium Concentration ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Chinese Patients ◽  
Maintenance Hemodialysis ◽  
Cox Regression Analysis ◽  
Media Thickness ◽  
Average Change ◽  
Dialysate Calcium

Background and Aim: The study aimed to prospectively evaluate the effects of lowering the dialysate calcium concentration (DCa) to 1.25 mmol/l on Chinese patients undergoing maintenance hemodialysis (MHD), which are largely unknown to date. Methods: A singer-center, prospective, randomized trial was conducted for 2 years. The DCa in one group was decreased from 1.5 to 1.25 mmol/l but there was no change in the other group. The clinical outcomes, biochemical parameters, medicine treatments and markers of vascular change were compared among the 2 groups at different time intervals. Results: At baseline, the groups were similar with respect to serum levels of calcium, phosphorus, intact parathyroid hormone and fibroblast growth factor-23 as well as carotid intima-media thickness (cIMT) and carotid-femoral pulse wave velocity (cf-PWV). It was found that the serum phosphorus concentration in the lower DCa group had decreased markedly at 2-year follow-up (0-month: 7.13 ± 1.56 mg/dl; 24-month: 5.92 ± 1.73 mg/dl; p = 0.005). Serum calcium (p = 0.018), cIMT (p = 0.029) and cf-PWV (p = 0.024) in DCa 1.25 group were significantly lower than those in 1.5 group at the 24-month visit. Kaplan-Meier curve revealed that patients in DCa 1.25 group had a better rate of survival. In the multivariate Cox regression analysis, cIMT (HR 1.010; 95% CI 1.002-1.217; p = 0.015) and cf-PWV (HR 1.265; 95% CI 1.022-1.567; p = 0.031) were potential risk factors for mortality in those patients. Importantly, we showed that the average change in these 2 risk variables were both associated with the average change in levels of serum calcium and phosphorus. Conclusion: Our results indicate that lowering DCa to 1.25 mmol/l may be suitable for the MHD patients in our unit.

Transperitoneal Calcium Mass Transfer using Dialv Sate with a Low Calcium Concentration (1.0 mM)

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 467-470 ◽  
Author(s):  
Thomas Weinreich ◽  
A. Colombi ◽  
H.H. Echterhoff ◽  
G. Mielke ◽  
M. Nebel ◽  
...  
Keyword(s):  
Mass Transfer ◽  
Calcium Concentration ◽  
Phosphate Binders ◽  
Total Serum ◽  
Vitamin D Metabolites ◽  
Low Calcium ◽  
Total Serum Calcium ◽  
Before And After ◽  
To Receive ◽  
Dialysate Calcium

Lower dialysate calcium concentrations were recently proposed to overcome the risk of hypercalcemia In continuous ambulatory peritoneal dialysis (CAPD) patients on calcium containing phosphate binders and/or vitamin D metabolites using the standard dialysate calcium concentration (sCa) of 1.75 mM. To assess transperitoneal calcium mass transfer (CaMT) in CAPD patients using a dialysate with a low calcium concentration (LCa, 1.00 mM), 18 stable patients were randomly allocated to receive either LCa or SCa. CaMT was assessed over 4 hours using 2L dialysate bags with three different dialysate glucose concentrations (1.5%, 2.3%, 4.25%). Total serum calcium (tCa), Ionized calcium (iCa), and the exact dialysate volume were measured before and after the 4-hour dwell. A sample of the drained dialysate was obtained to measure the dialysate calcium concentration. The tCa and iCa levels were not significantly different In both groups prior to and did not change throughout the test. CaMT (median/range) was .0.64 mmol/exchange (0.35 –1.29 mmol/exchange) using LCa with 1.5% glucose compared to 0.23 mmol (.0.18 -0.87 mmol) with SCa (p<0.0001). CaMT was negatively correlated to ICa and ultrafiltration volume [4.25%: LCa -1.22 (.0.84 -1.9); SCa .0.43 (-1.35 -0.13); p<0.001]. In summary, LCa results in a loss of calcium into the dialysate even at low ultrafiltration volumes and serum ICa levels. This might facilitate the prevention and therapy of renal osteodystrophy with calclum-containing phosphate binders and calcitriol. However, patients using LCa must be carefully monitored for calcium homeostasis and bone turnover.

scholarly journals Low-calcium dialysate stimulates parathormone secretion and its long-term use worsens secondary hyperparathyroidism.

1995 ◽  
Vol 6 (1) ◽  
pp. 132-135
Author(s):  
E Fernández ◽  
M Borràs ◽  
B Pais ◽  
J Montoliu
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Hemodialysis Patients ◽  
Clinical Effects ◽  
Calcium Balance ◽  
Serum Ipth ◽  
Low Calcium ◽  
High Calcium

The long-term clinical effects of the use of a low calcium concentration in the dialysate are largely unknown. For this reason, the influence of low-calcium dialysate on parathyroid hormone (PTH) secretion in hemodialysis patients and its long-term effect on the severity of secondary hyperparathyroidism were studied. In 35 hemodialysis patients, the dialysate calcium concentration was lowered from 1.75 to 1.25 mmol/L. Twelve months later, serum iPTH levels increased significantly from 18.6 to 33.2 pmol/L and so did alkaline phosphatase levels, from 210 to 330 IU/L, without significant changes in serum calcium or phosphorus levels. Hemodialysis with low-calcium dialysate (1.25 mmol/L) induced a net calcium loss in 10 patients, without modifications in ionized serum calcium levels. In addition, mean serum iPTH increased 20% over baseline levels, reaching the maximal level at 30 min after the start of hemodialysis with low-calcium dialysate. In contrast, mean serum iPTH levels drop dramatically at 30 min of hemodialysis with high-calcium dialysate (1.75 mmol/L). It was concluded that low-calcium dialysate worsens secondary hyperparathyroidism in hemodialysis patients, probably by inducing a negative calcium balance and causing repetitive stimulation of PTH secretion in each dialysis. The maintenance of normal serum calcium levels could be due to PTH-induced calcium mobilization from bone.

Calcium Excretion and Serum Calcium Concentration in Adult Intact and Gonadectomized Rats

Endocrinology ◽  
1968 ◽  
Vol 83 (6) ◽  
pp. 1375-1376 ◽  
Author(s):  
BERNARD F. RICE ◽  
ROY PONTHIER ◽  
M. CLINTON MILLER
Keyword(s):  
Serum Calcium ◽  
Calcium Concentration ◽  
Calcium Excretion ◽  
Serum Calcium Concentration
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