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Ionised calcium changes and parathyroid hormone secretion in haemodiafiltration in relation to substitution fluid
1Dialysis Unit, Ospedale Maggiore, Lodi, Italy.
This study was carried out to evaluate the acute effect of either 1.75 mmol/l calcium (A-HDF) or bicarbonate-containing and calcium-free (B-HDF) substitution fluid on calcium balance, serum ionised calcium, and intact parathyroid hormone (PTH) during haemodiafiltration (HDF: 1.3 m2 polysulphone dialyser; blood flow rate, 400 ml/min; treatment time 210 min; substitution fluid volume, 10 litres; dialysate calcium, 1.75 mmol/l). During A-HDF calcium balance was slightly positive (1.47 +/- 2.95 mmol), serum ionised calcium increased from 1.24 +/- 0.08 mmol/l to a final 1.46 +/- 0.05 mmol/l at the end of the treatment (P less than 0.001), and PTH decreased from 227 +/- 231 pg/ml to 150 +/- 123 pg/ml (P less than 0.01), during B-HDF calcium balance was negative (-3.06 +/- 1.3 mmol), ionised calcium decreased from 1.29 +/- 0.05 to 1.24 +/- 0.05 mmol/l (P less than 0.05) without inducing a statistically significant increase in PTH. However, in some patients the increase in PTH after treatment was greater than 50%. When the ultrafiltration rate was increased to 75-100 ml/min and bicarbonate-containing and calcium-free replacement fluid was used (B2-HDF), calcium balance became more negative (-9.75 +/- 4.55 mmol) and the decrease of ionised calcium was greater (from 1.3 +/- 0.06 to 1.14 +/- 0.04 mmol/l, P less than 0.01) inducing a significant increase of PTH (from 297 +/- 366 to 443 +/- 518 pg/ml, P less than 0.01). PTH changes were negatively correlated (r = -0.85) to ionised calcium changes during the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
This study was carried out to evaluate the acute effect of either 1.75 mmol/l calcium (A-HDF) or bicarbonate-containing and calcium-free (B-HDF) substitution fluid on calcium balance, serum ionised calcium, and intact parathyroid hormone (PTH) during haemodiafiltration (HDF: 1.3 m2 polysulphone dialyser; blood flow rate, 400 ml/min; treatment time 210 min; substitution fluid volume, 10 litres; dialysate calcium, 1.75 mmol/l). During A-HDF calcium balance was slightly positive (1.47 +/- 2.95 mmol), serum ionised calcium increased from 1.24 +/- 0.08 mmol/l to a final 1.46 +/- 0.05 mmol/l at the end of the treatment (P less than 0.001), and PTH decreased from 227 +/- 231 pg/ml to 150 +/- 123 pg/ml (P less than 0.01), during B-HDF calcium balance was negative (-3.06 +/- 1.3 mmol), ionised calcium decreased from 1.29 +/- 0.05 to 1.24 +/- 0.05 mmol/l (P less than 0.05) without inducing a statistically significant increase in PTH. However, in some patients the increase in PTH after treatment was greater than 50%. When the ultrafiltration rate was increased to 75-100 ml/min and bicarbonate-containing and calcium-free replacement fluid was used (B2-HDF), calcium balance became more negative (-9.75 +/- 4.55 mmol) and the decrease of ionised calcium was greater (from 1.3 +/- 0.06 to 1.14 +/- 0.04 mmol/l, P less than 0.01) inducing a significant increase of PTH (from 297 +/- 366 to 443 +/- 518 pg/ml, P less than 0.01). PTH changes were negatively correlated (r = -0.85) to ionised calcium changes during the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)