Low calcium dialysate combined with CaCO₃ in hyperphosphatemia in hemodialysis patients

This aim of this study was to observe the effects of the application of low calcium dialysate (LCD) combined with oral administration of CaCO₃ in the treatment of hyperphosphatemia, as well as blood Ca²⁺, calcium-phosphate product (CPP), parathyroid hormone (PTH) and blood pressure in patients undergoing hemodialysis. Thirty-one maintenance hemodialysis (MHD) patients with hyperphosphatemia, but normal blood Ca²⁺, underwent dialysis with an initial dialy-sate Ca²⁺ concentration (DCa) of 1.50 mmol/l for six months and then with 1.25 mmol/l for six months. The patients who underwent dialysis with a DCa of 1.25 mmol/l were treated orally with 0.3 g CaCO₃ tablets three times a day. In the third and sixth months [observation end point (OEP)] of the dialysis, the concentrations of Ca²⁺, phosphorus and intact PTH (iPTH) were measured; blood pressure and side-effects prior to and following dialysis were also observed. The Ca²⁺, CPP and iPTH levels increased (P<0.05) in the sixth month of treatment with a DCa of 1.50 mmol/l. However, the Ca²⁺ concentration declined to a certain degree, CPPs decreased significantly (P<0.05) and the iPTH concentration increased following treatment with a DCa of 1.25 mmol/l for six months. The incidence rate of adverse effects of LCD was 12.9% (4/31); the effects were mainly muscle spasms, hypotension and elevated PTH. The periodic application of LCD combined with the oral administration of CaCO₃ effectively reduced serum phosphorus and CPPs among MHD patients with hyperphosphatemia, indicating that the treatment may be used clinically.