A feasibility study of avoiding positive calcium balance and parathyroid hormone increase in patients on peritoneal dialysis

Piraciaba, Maria Clara Teixeira; Cordeiro, Lilian; Guimarães, Erica Adelina; Abensur, Hugo; Pereira, Benedito; Jorgetti, Vanda; Moysés, Rosa Maria Affonso; Elias, Rosilene Motta

doi:10.1016/j.bonr.2022.101625

Cited by 2 publications

(4 citation statements)

References 31 publications

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“…In our study, the increase was 25% (from 39.63 ± 28.27 to 49.54 ± 20.72). In our case series, AF levels remained stable, which is in line with a previous study [23].…”

Section: Case Reports In Nephrology and Dialysissupporting

confidence: 93%

“…The present study suggests that it appears safe to reduce calcium levels, thereby likely avoiding a positive calcium balance with potential harmful effects. It has been shown previously that a rise in PTH can be well managed with calcium-containing phosphate binders or calcimimetics [ 23 ]. Although robust data on calcium balance and clinical outcome in PD patients are lacking, conservative use of high calcium-containing PD fluids seems appropriate.…”

Section: Discussionmentioning

confidence: 99%

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Bone Mineral Parameters in Peritoneal Dialysis Patients after Lowering Calcium Concentration in Dialysis Fluids: A Case Series in Patients Using Icodextrin

Verschuur,

Liefting,

van Dam

et al. 2023

Case Rep Nephrol Dial

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In patients treated with peritoneal dialysis (PD), lowering the calcium level in PD fluids results in lower serum calcium levels and higher parathyroid hormone (PTH) levels. It is hypothesized that this effect is attenuated when patients are using icodextrin 7.5% for the once-daily long dwell (containing high calcium concentration). In this case series, we included 8 stable PD patients (mean age 68 ± 13 years, 7 male), all using icodextrin 7.5% (containing 1.75 mmol/L calcium) for the once-daily long dwell. The calcium content of the PD fluids for the remaining dwells was lowered from 1.75 mmol/L to 1.25 mmol/L. Bone mineral parameters and phosphate prescription at baseline, 6 weeks after this change, and after 6 months were compared. After lowering calcium concentration of the PD fluids – except for the icodextrin 7.5% – from 1.75 mmol/L to 1.25 mmol/L, calcium levels changed from 2.32 ± 0.11 to 2.29 ± 0.12 (p = NS); intact PTH (iPTH) from 39.6 ± 28.3 to 64.9 ± 34.5 pmol/L (p = 0.045); and alkaline phosphatase from 104.13 ± 48.75 to 101.38 ± 32.39 (p = NS). After 6 months, all bone mineral parameters were similar to baseline levels; however, slightly higher calcium-based phosphate binders were prescribed. Lowering calcium content from 1.75 mmol/L to 1.25 mmol/L in PD fluids in patients on icodextrin resulted in stable calcium values, a temporal increase in iPTH and a modest increase in calcium-based phosphate binder prescription. Using icodextrin for the long once-daily dwell appears to attenuate the effects on bone mineral parameters when lowering the calcium concentration of the short dwells.

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“…In our study, the increase was 25% (from 39.63 ± 28.27 to 49.54 ± 20.72). In our case series, AF levels remained stable, which is in line with a previous study [23].…”

Section: Case Reports In Nephrology and Dialysissupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Bone Mineral Parameters in Peritoneal Dialysis Patients after Lowering Calcium Concentration in Dialysis Fluids: A Case Series in Patients Using Icodextrin

Verschuur,

Liefting,

van Dam

et al. 2023

Case Rep Nephrol Dial

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“…Historically, glucose-containing PD dialysates had a calcium concentration of 1.75 mmol/L. Studies involving CAPD patients who were switched from 1.75 to 1.25 mmol/L dialysates [ 22 ], or comparing patients using both dialysates [ 23 ], showed that although PTH values increased, this could be compensated by increasing alfacalcidol prescription, and no changes in bone biopsy histology were reported [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…2 Risk factors for a positive calcium balance in peritoneal dialysis patients Table 2 Patient demographics and body composition and bone densitometry measured by dual-energy x-ray absorptiometry (DXA), with patients divided into those according to net calcium peritoneal and urinary balance and prescribed elemental calcium from calcium containing phosphate binders Data expressed as integers, percentages, mean ± standard deviation and median (interquartile range). T and Z scores according to world health organization definitions [9] dialysates [22], or comparing patients using both dialysates [23], showed that although PTH values increased, this could be compensated by increasing alfacalcidol prescription, and no changes in bone biopsy histology were reported [23]. More patients treated by CCPD had a positive peritoneal calcium balance when compared to APD, with all but 4 (5.1%) CCPD patients receiving icodextrin with a concentration of 1.75 mmol/L as the day exchange.…”

Section: Discussionmentioning

confidence: 99%

Calcium balance in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) cyclers

Davenport

2023

J Nephrol

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Introduction Although vascular calcification is a recognised complication for haemodialysis patients, peritoneal dialysis (PD) patients are also at risk. As such we wished to review peritoneal and urinary calcium balance and the effect of calcium containing phosphate binders (CCPBs). Methods Twenty-four-hour peritoneal calcium balance and urinary calcium were reviewed in PD patients undergoing their first assessment of peritoneal membrane function. Results Results from 183 patients, 56.3% male, 30.1% diabetic, mean age 59.4 ± 16.4 years, median 2.0 (2–6) months of PD, 29% treated by automated PD (APD), 26.8% continuous ambulatory (CAPD) and 44.2% APD with a day-time exchange (CCPD) were reviewed. Peritoneal calcium balance was positive in 42.6%, and remained positive in 21.3% after including urinary calcium losses. PD calcium balance was negatively associated with ultrafiltration (odds ratio 0.99 (95% confidence limits 0.98–0.99), p = 0.005. PD calcium balance was lowest with APD (APD − 0.45 (− 0.78 to 0.05) vs CAPD − 0.14 (− 1.18 to 0.59) vs CCPD − 0.03) − 0.48 to 0.5) mmol/day), p < 0.05, with 82.1% of patients with a positive balance prescribed icodextrin, when combining peritoneal and urinary losses. When considering CCPB prescription, then 97.8% of subjects prescribed CCPD had an over-all positive calcium balance. Discussion Over 40% of PD patients had a positive peritoneal calcium balance. Elemental calcium intake from CCPB had a major effect on calcium balance, as median combined peritoneal and urinary calcium losses were < 0.7 mmol/day (26 mg), so caution is required to prevent excessive CCPB prescribing, increasing the exchangeable calcium pool and thus potentially increasing vascular calcification, particularly for anuric patients. Graphical abstract

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A feasibility study of avoiding positive calcium balance and parathyroid hormone increase in patients on peritoneal dialysis

Cited by 2 publications

References 31 publications

Bone Mineral Parameters in Peritoneal Dialysis Patients after Lowering Calcium Concentration in Dialysis Fluids: A Case Series in Patients Using Icodextrin

Bone Mineral Parameters in Peritoneal Dialysis Patients after Lowering Calcium Concentration in Dialysis Fluids: A Case Series in Patients Using Icodextrin

Calcium balance in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) cyclers

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