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Optimizing the dialysate calcium concentration in bicarbonate haemodialysis
Gianmario Bosticardo1, Fabio Malberti, Carlo Basile
1Hospital-Territory Department, Nephrology and Dialysis Unit, Ospedale degli Infermi, Biella, Italy. gmbostic@alice.it
Summary
Dialysate calcium concentration (DCa) choice in hemodialysis (HD) impacts patient safety. Using 1.25 mmol/L DCa results in neutral calcium balance, while 1.5 mmol/L DCa leads to calcium gain during HD.
Area of Science:
- Nephrology
- Clinical Chemistry
Background:
- Optimal dialysate calcium concentration (DCa) in hemodialysis (HD) lacks consensus.
- Low DCa risks arrhythmias; high DCa risks calcifications.
Purpose of the Study:
- To evaluate calcium mass balance (CMB) with different DCa levels during HD.
- To compare the net calcium transfer between dialysate and blood.
Main Methods:
- Twenty-two HD patients underwent HD sessions with 1.5 and 1.25 mmol/L total DCa.
- Calcium mass balance (CMB) was calculated using ionized calcium (iCa) and kinetic formulas.
Main Results:
- Mean blood iCa increased with 1.5 DCa, remaining unchanged with 1.25 DCa.
- 1.5 DCa resulted in a net calcium transfer from dialysate to blood.
- 1.25 DCa showed an approximately neutral calcium flux.
Conclusions:
- 1.25 DCa yields near-neutral CMB, while 1.5 DCa causes calcium gain during HD.
- Choice of DCa requires balancing Ca load risks with hemodynamic tolerance.
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