Related Experiment Video
Updated: May 1, 2026
A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Calcium profiling in hemodiafiltration: a new way to reduce the calcium overload risk without compromising
Stefano Severi1, Piergiorgio Bolasco, Fabio Badiali
13 Nephrology and Dialysis Unit, ASL 8, Quartu S. Elena - Italy.
Insights
Time-profiled dialysate calcium (Ca²⁺) in hemodiafiltration maintains hemodynamic stability and favorable QT interval changes, unlike low Ca²⁺, while avoiding calcium overload associated with high Ca²⁺.
Area of Science:
- Nephrology
- Cardiovascular Physiology
- Dialysis Therapy
Background:
- Dialysate calcium (Ca²⁺) concentration impacts hemodynamics, cardiac function, and mineral metabolism.
- Both low and high dialysate Ca²⁺ present risks, including hemodynamic instability and cardiovascular calcification.
- A time-profiled approach may balance Ca²⁺ benefits and risks.
Purpose of the Study:
- To investigate the effects of time-profiled dialysate calcium (Pd(Ca)) on hemodynamics and calcium balance.
- To compare Pd(Ca) with low (Ld(Ca)) and high (Hd(Ca)) constant dialysate calcium concentrations.
- To assess cardiovascular safety and calcium loading during different dialysate calcium regimens.
Main Methods:
- Prospective, multicenter study involving 22 patients undergoing hemodiafiltration.
- Randomized crossover design with three 3-week periods: Ld(Ca) (1.25 mM), Hd(Ca) (2 mM), and Pd(Ca).
- Monitoring of plasma Ca²⁺, arterial pressures (SAP, DAP), and corrected QT interval (QTc).
Main Results:
- Plasma Ca²⁺ decreased with Ld(Ca), increased with Hd(Ca), and showed a moderate increase with Pd(Ca).
- Hemodynamic parameters (SAP, DAP) were stable with Hd(Ca) and Pd(Ca), but decreased with Ld(Ca).
- QTc interval significantly increased to critical levels only with Ld(Ca).
Conclusions:
- Time-profiled dialysate calcium (Pd(Ca)) appears to preserve cardiovascular benefits of high Ca²⁺.
- Pd(Ca) demonstrates improved hemodynamic stability and QTc interval compared to low Ca²⁺.
- This approach mitigates the excessive positive calcium balance associated with high Ca²⁺ dialysis.
Background:
Low and high dialysate calcium (Ca²⁺) content may have positive and harmful effects depending on the considered pathological aspect: hemodynamic instability, cardiac arrhythmias, parathormone release, adynamic bone disease, cardio-vascular calcifications. We hypothesized that a time-profiled Ca²⁺ concentration would keep the cardiovascular advantages of high Ca²⁺ but would reduce the risk of calcium overload.
Methods:
A prospective, multicenter study using a particular hemodiafiltration technique that allows the profiling of electrolytes was designed. Patients (n = 22) underwent randomly a 3-week dialysis session with low and high constant dialysate Ca²⁺ (Ld(Ca,), 1.25 mM and Hd(Ca,), 2 mM) and profiled Ca²⁺ (Pd(Ca)), respectively. Plasma and spent dialysate Ca²⁺, systolic and diastolic arterial pressure (SAP, DAP) and QT interval corrected for heart rate (QTc) were analyzed.
Results:
Plasma Ca²⁺ concentration decreased in Ld(Ca), whereas it increased in Hd(Ca) and to a lesser extent, in Pd(Ca). Total amount of Ca²⁺ given to the patient in Pd(Ca) (15.5 ± 1.0 mmol) was higher than in Ld(Ca) (4.3 ± 1.6 mmol) but lower than in Hd(Ca) (21.9 ± 3.3 mmol). SAP and DAP decreased in Ld(Ca), whereas it was almost constant in both Hd(Ca) and Pd(Ca·). QTc significantly increased, up to critical values (>460 msec), only during Ld(Ca·).
Conclusions:
Pd(Ca) seems to retain the advantages of high Ca²⁺ in terms of hemodynamic stability and modification of QTc while reducing the excessive positive calcium balance typical of dialysis with high Ca²⁺ content.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:25Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration
01:25Hemodialysis III: Nursing Management
01:24Hemodialysis II: Procedure and Complications
01:26Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy
01:25Hemodialysis I: Introduction