Improvement of bone and mineral parameters related to adynamic bone disease by diminishing dialysate calcium

Spasovski, Goce; Gelev, Saso; Masin-Spasovska, Jelka; Selim, Gjulsen; Šikole, Aleksandar; Vanholder, Raymond

doi:10.1016/j.bone.2007.06.014

Cited by 50 publications

(33 citation statements)

References 30 publications

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“…Studies have shown that dialysate calcium concentration of 1.5 mmol/l is a positive calcium balance [16]. 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].…”

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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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%

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

Xiong

et al. 2016

Blood Purif

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“…A redução da concentração de Ca no dialisato (tanto na diálise peritoneal quanto na hemodiálise) favorece o aumento dos ní-veis de PTH e, consequentemente, melhora da remodelação óssea. [15][16][17] Dessa forma, pacientes com DOA devem receber quelantes de P isentos de Ca 1 e serem dialisatos com menor concentração de Ca. O uso de teriparatide (PTH 1-34 recombinante humano) teoricamente deveria restaurar a remodelação óssea.…”

Section: Racionalunclassified

Doença óssea adinâmica

Oliveira¹,

Moysés²,

Rocha³

et al. 2011

J. Bras. Nefrol.

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“…Dialysis with 1.5 m M Ca dialysate results in a nil Ca balance in the patients arriving to dialysis with a normal Ca level, whilst dialysis with a 1.25-m M Ca content results in a negative Ca balance [19]. Spasovski et al [20] in a randomized controlled study comparing 1.25 vs. 1.75 m M dialysate Ca observed improved markers of bone remodeling in a group of dialysis patients with biological adynamic bone disease. This remains an area of controversy [21].…”

Section: Methods In Producing Guidelinesmentioning

confidence: 99%

Chronic Kidney Disease-Related Mineral and Bone Disorders

Argilés¹,

Vanholder

2009

Nephron Clin Pract

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The clinical practice guidelines, their scope, limitations and applicability within the field of mineral and bone disorders have been analyzed. The different available guidelines have been compared and their content has been put into the perspective of the user. The aim has been to review their accuracy and relevance for the key set of mineral and bone disorders, and not to attempt to rewrite them or provide new guidelines based on the authors’ feelings and experience.

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Improvement of bone and mineral parameters related to adynamic bone disease by diminishing dialysate calcium

Cited by 50 publications

References 30 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

Doença óssea adinâmica

Chronic Kidney Disease-Related Mineral and Bone Disorders

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