Biological impact of targeted dialysate calcium changes in haemodialysis patients: the key role of parathyroid hormone

Gadrey, Jean; Mayor, Brice; Hurot, Jean-Marc; Deléaval, Patrik; Lorriaux, Christie; Zaoui, Éric; Chazot, Charles

doi:10.1093/ndt/gfs119

Cited by 27 publications

(23 citation statements)

References 32 publications

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“…For the patients with normal pre-dialysis serum calcium levels, if the calcium ion concentration of >1.5 mmol/l dialysate was used, there could be 20.0-83.3% of patients who suffered from hypercalcemia and increased the incidence of metastatic calcification [17]. Another study also showed that positive calcium balance could also facilitate or accelerate the soft tissue and vascular calcification even in the absence of hypercalcemia [18]. Jean et al [18] reported that increasing DCa from 1.25 to 1.5 mmol/l and from 1.5 to 1.75 mmol/l led to a significant increase of calcemia and a decrease of phosphatemia, total ALP (tALP) and PTH.…”

Section: Discussionmentioning

confidence: 99%

“…Another study also showed that positive calcium balance could also facilitate or accelerate the soft tissue and vascular calcification even in the absence of hypercalcemia [18]. Jean et al [18] reported that increasing DCa from 1.25 to 1.5 mmol/l and from 1.5 to 1.75 mmol/l led to a significant increase of calcemia and a decrease of phosphatemia, total ALP (tALP) and PTH. Decreasing DCa from 1.75 to 1.5 mmol/l and from 1.5 to 1.25 mmol/l led to a decrease of calcemia and an increase of phosphatemia, tALP and PTH in 78 patients [19].…”

Section: Discussionmentioning

confidence: 99%

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The Study of Low Calcium Dialysate on Elderly Hemodialysis Patients with Secondary Hypoparathyroidism

Xiong

et al. 2016

Blood Purif

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Objective: The study aimed to study the safety and efficacy of 1.25 mmol/l calcium dialysate on maintenance hemodialysis (MHD) in elderly patients who suffered from secondary hypoparathyroidism. Methods: Eighty-two elderly patients (ages ≥65) who had been in MHD with dialysate calcium at 1.5 mmol/l over 6 months and had 2 consecutive serum intact parathyroid hormone (iPTH) measurements at level below 100 pg/ml were selected and randomized into 2 groups: treatment group (41 patients, with dialysate calcium at 1.25 mmol/l) and control group (41 patients, still with dialysate calcium at 1.5 mmol/l). Both groups were studied for the duration of 12 months. The changes of serum iPTH, calcium, phosphorus, calcium and phosphorus product and other indicators as well as related adverse reactions were recorded at the following time points: before the study and 1, 3, 6 and 12 months into the study. In addition, the intimal media thickness (IMT) of carotid artery and abdominal aorta calcification score (AACS) were measured in the 0, 6 and 12 months during the study. Results: (1) In the treatment group, the levels of serum corrected calcium, phosphorus and calcium-phosphate product began to decline after 1 month and exhibited further decrease 3 months later. Serum iPTH level increased significantly after 1 month into the study and the trend continued. The above markers stabilized after month 6. Compared with pre-study markers, the changes of the above markers were significant after study (p < 0.05). (2) The average IMT and AACS were evidently decreased during the 6 and 12 months of study in the treatment group. There was statistical significance (p < 0.05) when compared with the above indexes of the pre-study and the control group. (3) In the control group, there were no significant differences in above laboratory markers over the 12-month study period. (4) There was no significant difference in the adverse events observed between the 2 groups. Conclusion: Safety of low calcium dialysate (dialysate calcium 1.25 mmol/l) in elderly MHD patients with iPTH <100 pg/ml is good, as well as improving carotid IMT, resistance index and AACS as indexes of vascular calcification in the small study group and warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Study of Low Calcium Dialysate on Elderly Hemodialysis Patients with Secondary Hypoparathyroidism

Xiong

et al. 2016

Blood Purif

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“…A study comparing the three different DCa concentrations have demonstrated that, compared to DCa > 1.25 and < 1.25 mmoL/L that expose patients to positive and negative CaB, respectively, DCa = 1.25 mmol/L is associated to a neutral one. Beyond Ca levels, DCa variations might influence the other MM parameters also significantly, especially PTH [19].…”

Section: Dialysis Schedulementioning

confidence: 99%

The Importance of Adherence in the Treatment of Secondary Hyperparathyroidism

et al. 2018

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Secondary hyperparathyroidism (SHPT) is a frequent condition in the presence of chronic kidney disease (CKD). In CKD patients, SHPT is reported to increase both morbidity and mortality, especially cardiovascular. The difficulty in the treatment of SHPT in clinical practice is frequently encountered from a not always adequate conduct of the clinicians and a common non-compliance to the therapy of CKD patients. In this review, the greatest difficulties from clinicians and CKD-patients’ point of view in the treatment of SHPT will be addressed, with particular attention to those related to dialysis features, nutritional habits, and medical therapy.

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“…However, KDOQI experts support the idea of individualizing Ca concentration according to serum Ca and other biochemical parameters [76]. In fact, studies in hemodialysis patients show how increases in dialysate Ca are accompanied by a marked decrease in circulating PTH levels [77,78].…”

Section: Nutritional Vitamin D Therapymentioning

confidence: 99%

Advances in pharmacotherapy for secondary hyperparathyroidism

Rodríguez

Rodríguez‐Ortiz

2015

Expert Opinion on Pharmacotherapy

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PTH increases from early stages of renal disease. One of the goals in pre-dialysis is the prevention of hyperphosphatemia and the maintenance of Ca levels in the normal range. The management of hyperparathyroidism in dialysis requires control of phosphorus level. In this stage, the decision to use calcimimetics and vitamin D derivatives should be made according to serum levels of Ca and phosphorus.

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Biological impact of targeted dialysate calcium changes in haemodialysis patients: the key role of parathyroid hormone

Abstract: DCa individualization has a significant impact on mineral metabolism parameters, especially on serum PTH levels, and could be considered as an additional therapy in a more global strategy together with phosphate binder, vitamin D and calcimimetics prescription.

Cited by 27 publications

References 32 publications

The Study of Low Calcium Dialysate on Elderly Hemodialysis Patients with Secondary Hypoparathyroidism

The Study of Low Calcium Dialysate on Elderly Hemodialysis Patients with Secondary Hypoparathyroidism

The Importance of Adherence in the Treatment of Secondary Hyperparathyroidism

Advances in pharmacotherapy for secondary hyperparathyroidism

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