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Whole blood versus serum ionized calcium concentrations in dialysis patients

Seok Hui Kang1, Kyu Hyang Cho1, Jong Won Park1

  • 1Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.

The Korean Journal of Internal Medicine
|March 21, 2014
PubMed

Insights

Serum ionized calcium is significantly higher than whole blood ionized calcium. Whole blood ionized calcium measurements may underestimate calcium levels, especially in hypocalcemia cases.

Area of Science:

  • Clinical Chemistry
  • Nephrology
  • Laboratory Medicine

Background:

  • Accurate measurement of ionized calcium is crucial for patient management, particularly in hemodialysis.
  • Heparinized whole blood and serum are common sample types for calcium testing.

Purpose of the Study:

  • To quantify the difference in ionized calcium levels between heparinized whole blood and serum.
  • To evaluate the clinical implications of these differences in hemodialysis patients.

Main Methods:

  • Recruitment of 107 maintenance hemodialysis patients.
  • Measurement of ionized calcium in both serum and heparinized whole blood samples.
  • Statistical analysis including Bland-Altman analysis and kappa agreement.

Main Results:

  • Serum ionized calcium levels were consistently higher than whole blood levels (p < 0.001).
  • Bland-Altman analysis revealed a mean difference of 0.5027 mg/dL.
  • Significant differences in categorized ionized calcium levels were observed between the two methods (κ = 0.279, p < 0.001).

Conclusions:

  • Whole blood ionized calcium is underestimated compared to serum ionized calcium.
  • The underestimation of whole blood ionized calcium increases as the measured level decreases.
  • Hypocalcemia detected in whole blood ionized calcium requires confirmation with serum ionized calcium testing.
Abstract

Keywords:
HeparinHypocalcemiaRenal dialysis

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