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Calcium balance and intact PTH variations during haemodiafiltration
1Centre de Recherche Biochimie Macromoléculaire (CRBM), University Hospital Lapeyronie, Montpellier, France.
Summary
Lowering dialysate calcium to 1.25 mM in hemodialysis patients may lead to a negative calcium balance and a rise in parathormone levels. This highlights challenges in managing secondary hyperparathyroidism during dialysis.
Area of Science:
- Nephrology
- Mineral and Bone Disorder
Background:
- Secondary hyperparathyroidism is common in dialysis patients.
- Decreasing dialysate calcium (Ca) content is a strategy to manage this condition.
- Lowering dialysate Ca to 1.25 mM has been observed to increase parathormone (PTH) levels despite controlled predialysis Ca and phosphate.
Purpose of the Study:
- To assess total calcium balance during hemodialysis.
- To investigate modifications in parathormone levels induced by dialysis sessions.
- To understand the reasons behind PTH elevation with low dialysate Ca.
Main Methods:
- Fourteen hemodialysis patients participated.
- Patients were divided into two groups receiving dialysate Ca of 1.5 mM or 1.25 mM.
- Serum and dialysate Ca, phosphate, and parathormone were measured before and after dialysis.
Main Results:
- Serum ionized Ca increased with 1.5 mM but not 1.25 mM dialysate Ca.
- Total Ca balance decreased significantly with 1.25 mM dialysate Ca.
- Phosphate removal was higher with 1.25 mM dialysate Ca, and parathormone decreased with 1.5 mM but not 1.25 mM dialysate Ca.
Conclusions:
- Assessing calcium balance in dialysis is complex.
- Phosphate content influences dialysate ionized calcium levels.
- Negative calcium balance and lack of PTH inhibition with 1.25 mM dialysate Ca may contribute to hyperparathyroidism relapse.