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Effect of lower calcium dialysate on laboratory abnormalities in chronic kidney disease-associated mineral and bone

Anip Bansal1, Gagangeet Sandhu, Rohit A Chitale

  • 1Division of Nephrology, Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY 10025, USA.

American Journal of Therapeutics
|October 25, 2011
PubMed

Insights

Lowering dialysate calcium in hemodialysis significantly reduced serum calcium levels. This intervention did not increase parathyroid hormone or vitamin D analog requirements, offering a potential strategy to reduce vascular calcification risk in end-stage renal disease patients.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Vascular calcification, linked to cardiovascular disease in end-stage renal disease (ESRD) patients, is often associated with excess calcium (Ca) and phosphate.
  • Lowering dialysate Ca concentration is a proposed method to prevent long-term Ca accumulation.

Purpose of the Study:

  • To investigate the impact of decreasing dialysate Ca concentration on serum Ca levels, parathyroid hormone (PTH), and medication requirements in maintenance hemodialysis patients.
  • To evaluate the feasibility of reducing total Ca load in ESRD patients undergoing hemodialysis.

Main Methods:

  • A single outpatient dialysis center reduced standard dialysate Ca concentration from 2.5 to 2.25 mEq/L in September 2009.
  • Serum Ca and intact parathyroid hormone (iPTH) levels were monitored in maintenance hemodialysis patients.

Main Results:

  • A significant reduction in mean serum Ca concentration was observed after lowering the dialysate Ca.
  • No significant increase in serum parathyroid hormone levels was detected.
  • There was no increase in the requirement for vitamin D analogs or Ca-based phosphate binders.

Conclusions:

  • Reducing dialysate Ca concentration in maintenance hemodialysis is effective in lowering serum Ca without adversely affecting PTH levels or medication needs.
  • This intervention shows promise for decreasing the overall Ca load in ESRD patients.
  • Further research is warranted to determine the long-term effects on cardiovascular morbidity and mortality.

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