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What is the appropriate dialysate calcium concentration for the dialysis patient?
E Ritz1, J Passlick-Deetjen, J Lippert
1Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany.
Insights
Lowering dialysate calcium in dialysis may risk negative calcium balance and increase parathyroid hormone. Individualized calcium levels are crucial for dialysis patients, balancing hypercalcemia risks with potential deficiencies.
Area of Science:
- Nephrology
- Mineral and Bone Disorder
Background:
- A trend exists to reduce dialysate calcium concentrations due to hypercalcemia associated with calcium-based phosphate binders.
- A single, universally suitable dialysate calcium concentration for all dialysis patients has not been established.
Purpose of the Study:
- To examine the risks and considerations associated with lowering dialysate calcium concentrations in dialysis patients.
- To highlight the factors influencing hypercalcemia risk and calcium balance in hemodialysis.
Main Methods:
- Analysis of intradialytic calcium transport (diffusive and convective).
- Evaluation of interdialytic calcium balance, including intestinal absorption.
- Consideration of patient compliance with phosphate binder therapy.
Main Results:
- Lower dialysate calcium concentrations can lead to negative calcium balance.
- Reduced dialysate calcium may increase parathyroid hormone levels, especially with non-adherence to binders.
Conclusions:
- Dialysate calcium concentration requires careful individualization in dialysis patients.
- Lowering dialysate calcium poses risks of negative calcium balance and secondary hyperparathyroidism.
Abstract:
Recently, there has been a trend to lower dialysate calcium concentrations because of the frequent occurrence of hypercalcaemia with the use of calcium-containing phosphate binders. No single dialysate calcium concentration is available which suits all dialysis patients. The risk of hypercalcaemia depends on intradialytic (diffusive and convective) calcium transport and interdialytic calcium balance (negative or positive intestinal balance). Low dialysate calcium concentrations expose the patient to the risks of negative calcium balance and increase in parathyroid hormone concentration, particularly if patients are non-compliant with the intake of calcium-containing phosphate binders.