Calcium Flux During Hemodialysis

Binswanger, U

doi:10.1111/j.1525-139x.1990.tb00001.x

Cited by 7 publications

(4 citation statements)

References 6 publications

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“…The diffusion of Ca in HD depends on the Ca gradient between the serum concentration and the dialysate concentration. Studies have shown that when the dialysate Ca is greater than 1.5 mmol/L, there is an expected gain in Ca 11,22,23 . Losses by convective transport, however, can exceed the amount of Ca gained by diffusion 22 so ultrafiltration is also an important factor in the overall Ca balance.…”

Section: Reviewmentioning

confidence: 99%

“…Studies have shown that when the dialysate Ca is greater than 1.5 mmol/L, there is an expected gain in Ca 11,22,23 . Losses by convective transport, however, can exceed the amount of Ca gained by diffusion 22 so ultrafiltration is also an important factor in the overall Ca balance. Ca mass balance studies have demonstrated that generally, providing the patient is normocalcemic, a dialysate Ca concentration of 1.75 mmol/L produces a positive Ca balance and a negative balance is obtained with a dialysate Ca of 1.25 mmol/L 23–25 .…”

Section: Reviewmentioning

confidence: 99%

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Review of dialysate calcium concentration in hemodialysis

Toussaint

Cooney

Kerr

2006

Hemodialysis International

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The dialysate calcium (Ca) concentration for hemodialysis (HD) patients can be adjusted to manage more optimally the body's Ca and phosphate balance, and thus improve bone metabolism as well as reduce accelerated arteriosclerosis and cardiovascular mortality. The appropriate dialysate Ca concentration allowing this balance should be prescribed to each individual patient depending on a multitude of variable factors relating to Ca load. A lower dialysate Ca concentration of 1.25 to 1.3 mmol/L will permit the use of vitamin D supplements and Ca-based phosphate binders in clinical practice, with much less risk of Ca loading and resultant hypercalcemia and calcification. Low Ca baths are useful in the setting of adynamic bone disease where an increase in bone turnover is required. However, low Ca levels in the dialysate may also predispose to cardiac arrhythmias and hemodynamically unstable dialysis sessions with intradialytic hypotension. Higher Ca dialysate is useful to sustain normal serum Ca levels where patients are not taking Ca-based binders or if Ca supplements are not able to normalize serum levels. Suppression of hyperparathyroidism is also effective with dialysate Ca of 1.75 mmol/L, but hypercalcemia, metastatic calcification, and oversuppression of parathyroid hormone are risks. Dialysate Ca of 1.5 mmol/L may be a compromise between bone protection and reduction in cardiovascular risk for conventional HD and is a common concentration used throughout the world. The increase in longer, more frequent dialysis such as short-daily and nocturnal HD, however, provides another challenge with regard to optimal dialysate Ca levels and higher levels of 1.75 mmol/L are probably indicated in this setting. Difficulties in determining the ideal dialysate Ca occur because of the complex pathophysiology of bone and mineral metabolism in HD patients and there needs to be a balance between dialysis prescription and other treatment modalities. To optimize management of the abnormal Ca balance, other aspects of this disorder need to be more fully clarified and, with evolving medications for phosphate control and treatment of secondary hyperparathyroidism, as well as the emergence of a multitude of different HD regimes, further studies are required to make definitive recommendations. At present, we need to maintain flexibility with HD treatments and so dialysate Ca needs to be individualized to meet the specific requirements of patients by optimizing management of renal bone disease and simultaneously reducing metastatic calcification and cardiovascular disease.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Review of dialysate calcium concentration in hemodialysis

Toussaint

Cooney

Kerr

2006

Hemodialysis International

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“…However, Ca mass balance studies have demonstrated a negative balance with a DCa of 2.5 mEq/l [23][24][25] and an even higher DCa ( 1 3 mEq/l) in convective therapies [26] . Low DCa, although perhaps a choice in patients with low iPTH levels [22] , could lead to a negative Ca balance, PTH stimulation and SHPT aggravation requiring vitamin D dose adjustments [3,20,22,27] .…”

Section: Discussionmentioning

confidence: 99%

Paricalcitol Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients on Sevelamer Hydrochloride: Which Dialysate Calcium Concentration to Use?

Sonikian¹,

Metaxaki²,

Karatzas³

et al. 2009

Blood Purif

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Background: Optimal dialysate calcium concentration (DCa) has not been determined under less hypercalcemic vitamin D analogues and Ca-free phosphate (P) binders. Methods: Twelve hyperparathyroidic hemodialysis patients under sevelamer hydrochloride were treated with paricalcitol in three periods (A, B and C) under DCa of 3.5, 3 and 2.5 mEq/l, respectively, in a 3-way open-label randomized crossover study. Results: Serum parathyroid hormone decreased in all periods. Under DCa = 2.5 mEq/l, there was a need for longer treatment duration, higher paricalcitol doses and increased sevelamer doses for higher serum P levels. No differences in serum Ca were observed. Ca × P values followed P changes. Episodes of Ca × P >55 mg²/dl² were more frequent in the C period. Conclusions: Under paricalcitol and sevelamer, serum parathyroid hormone decreased without Ca increase under any DCa. DCa of 2.5 mEq/l resulted in higher paricalcitol doses, increased serum P levels and more frequent high Ca × P episodes and may not be optimal with the new medications.

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“…Dann muss mit folgenden möglichen Nebenwirkungen gerechnet werden: einer osmotischen Flüssigkeitsverschiebung von extra-nach intrazellulär mit Symptomen wie allgemeine Schwäche, insbesondere Cephalgien, und gehäufte intradialytische Hypotonien. [16,17], wobei auch in solch einem Fall eine hohe Ultrafiltration zu einer neutralen oder sogar negativen Bilanz führen kann [17]. Die vorliegenden Bilanzierungsstudien zeigten, dass bei einem Dialysatkalzium von 1,25 mmol/l eine überwiegend kalziumneutrale Bilanz erreicht wird [18,19].…”

Section: Auswirkungen Einer Positiven Oder Negativen Natriumbilanzunclassified

Die Rolle der Dialysatzusammensetzung und -temperatur

Bokemeyer¹

2018

Dialyse aktuell

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ZusammenfassungDie Wahl der Dialysatzusammensetzung ist für die Verträglichkeit und die Vermeidung von Komplikationen einer Hämodialyse von elementarer Bedeutung. Während der Dialyse ist die Salzbilanz für die kardiovaskuläre Stabilität und die Blutdruckkontrolle relevant. Die Natriumkonzentration im Dialysat sollte an den individuellen Sollwert für die extrazelluläre Osmolarität angepasst werden. Ziel der Festlegung des Dialysatkaliums ist die sichere Vermeidung von Hyperkaliämien. Darüber hinaus sollte während der Dialyse eine neutrale Kalziumbilanz angestrebt werden, dies wird bei den meisten Patienten bei einer Kalziumkonzentration des Dialysats von 1,25 mmol/l erreicht. Auch das Bikarbonat sollte bei jedem Patienten so gewählt werden, dass zur Mitte der Woche ein Serumbikarbonat von über 22 mmol/l erreicht wird. Letztendlich ist auch die Wahl der richtigen Dialysattemperatur zur Vermeidung intradialytischer Hypotonien wichtig. Zusammengefasst sollte zur Steigerung der Verträglichkeit der Dialyse und zur Vermeidung von Spätkomplikationen das Dialysat individuell verordnet werden.

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Calcium Flux During Hemodialysis

Cited by 7 publications

References 6 publications

Review of dialysate calcium concentration in hemodialysis

Review of dialysate calcium concentration in hemodialysis

Paricalcitol Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients on Sevelamer Hydrochloride: Which Dialysate Calcium Concentration to Use?

Die Rolle der Dialysatzusammensetzung und -temperatur

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