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Acute dialysis hypercalcemia and dialysis phosphate loss
1University of Newcastle, Royal Newcastle Hospital, Australia.
Summary
Acute hypercalcemia during hemodialysis is linked to excessive phosphate loss. Replenishing phosphate during dialysis can prevent this rise, suggesting phosphate depletion contributes to bone disease in chronic renal failure patients.
Area of Science:
- Nephrology
- Mineral Metabolism
- Renal Failure
Background:
- Acute elevations in plasma calcium are common during maintenance hemodialysis for chronic renal failure.
- The underlying mechanisms of this dialysis-induced hypercalcemia remain unclear.
Purpose of the Study:
- To investigate the mechanisms behind acute hypercalcemia during hemodialysis.
- To determine the relationship between calcium, magnesium, and inorganic phosphate mass transfer and plasma calcium levels.
Main Methods:
- Collected mass transfer data for calcium, magnesium, and inorganic phosphate during routine hemodialysis.
- Compared hypercalcemia levels with dialysate calcium concentration and calcium/phosphate gains/losses.
- Evaluated the effect of hemodialysis without ultrafiltration and continuous phosphate infusion on hypercalcemia.
Main Results:
- Dialysis-induced hypercalcemia did not correlate with calcium gain from dialysate or dialysate calcium concentration.
- A significant positive correlation was observed between hypercalcemia and body phosphate loss (r = 0.66, P < 0.05).
- Hemodialysis without ultrafiltration reduced hypercalcemia by 46% (P < 0.001), and continuous phosphate infusion abolished it.
Conclusions:
- Excessive inorganic phosphate loss during hemodialysis contributes to hypercalcemia.
- Rapid plasma phosphate reduction may trigger release of intracellular phosphate and calcium, potentially from bone.
- Phosphate depletion during dialysis could be a significant factor in the development of renal osteodystrophy.