Skeletal and cardiovascular consequences of a positive calcium balance during hemodialysis

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Bone Metabolism

Background:

• Patients undergoing hemodialysis are routinely exposed to calcium through dialysate.
• Calcium transfer during dialysis is influenced by the serum-to-dialysate calcium gradient and bone turnover.
• The dialysate calcium concentration (d[Ca]) is often overlooked but can significantly impact calcium balance.

Purpose of the Study:

• To review the existing data and explore potential mechanisms linking dialysate calcium concentration to calcium balance.
• To discuss the consequent effects on skeletal, myocardial, and arterial function.

Main Methods:

• Literature review of studies investigating calcium balance in hemodialysis patients.
• Analysis of the pathophysiology of adverse effects related to altered calcium homeostasis.
• Discussion of organ-specific susceptibility to calcium dysregulation.

Main Results:

• Positive calcium balance can result from the d[Ca], leading to systemic organ damage.
• Adverse effects include mortality, myocardial dysfunction, hemodynamic instability, vascular calcification, and arrhythmias.
• Pathophysiological mechanisms involve serum calcium fluctuations, parathyroid hormone suppression, and direct/indirect vascular effects.

Conclusions:

• Dialysate calcium concentration is a critical factor influencing calcium balance in hemodialysis patients.
• Understanding the link between d[Ca] and organ dysfunction is crucial for patient management.
• Further research is needed to elucidate organ-specific susceptibilities and optimize d[Ca] settings.