Quantification of Dialytic Removal and Extracellular Calcium Mass Balance during a Weekly Cycle of Hemodialysis

Waniewski, Jacek; Dębowska, Małgorzata; Wójcik-Załuska, Alicja; Książek, Andrzej; Załuska, Wojciech

doi:10.1371/journal.pone.0153285

Cited by 17 publications

(14 citation statements)

References 34 publications

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“…Our data is in keeping with that of several studies, indicating that Ca mass balance in extracorporeal dialysis is the result of a diffusive and a convective component: the former is determined by an integration of dialysate to blood gradients of ionized and complexed Ca, and thus by plasma and dialysate Ca concentrations, the latter by fluid ultrafiltration [26-28]. Thus, great variations may occur between different treatment modes (diffusion-based vs convection-based), prescription (especially dialysate composition), patient characteristics and concomitant therapies.…”

Section: Discussionsupporting

confidence: 90%

“…Thus, great variations may occur between different treatment modes (diffusion-based vs convection-based), prescription (especially dialysate composition), patient characteristics and concomitant therapies. For high-volume convective treatments, a great increase in dialysate Ca concentration is needed to counteract convective losses [26]; in BHD, with the use of slightly lower dialysate Ca concentration than ours (i.e., 1.35 mM), a mean 75.6 mg/session negative Ca balance was measured, with great variations between a group of patients with negative balance (mean 170.5 mg/session) and a group with positive balance (mean 126.4 mg/session) [28]. Most of the variation occurred in the complexed rather than ionized Ca balance, whose reasons were not assessed but that speculatively might reside in differences in plasma and dialysate concentrations of anions.…”

Section: Discussionmentioning

confidence: 99%

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Phosphate and Calcium Control in Short Frequent Hemodialysis with the NxStage System One Cycler: Mass Balance Studies and Comparison with Standard Thrice-Weekly Bicarbonate Dialysis

Brunati¹,

Gervasi

Casati³

et al. 2018

Blood Purif

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Background: Short frequent dialysis with NxStage System One cycler (NSO) has become increasingly popular as home hemodialysis prescription. Short dialysis sessions with NSO might not allow adequate phosphate (P) removal. Methods: Single-session and weekly balances of P and calcium (Ca) were compared in 14 patients treated with NSO (6 sessions/week) and in 14 patients on standard bicarbonate dialysis (BHD). Results: NSO and BHD showed similar plasma P fall, with end-dialysis plasma P slightly lower in BHD (2.2 ± 0.5 vs. 2.7 ± 0.8 mg/dL, p < 0.02). Single-session P removal was lower in NSO, but weekly removal was higher (3,488 ± 1,181 mg vs. 2,634 ± 878, p < 0.003). Plasma Ca increase was lower in NSO, with similar PTH fall. Ca balance varied according to start plasma Ca, dialysate to blood Ca gradient and net ultrafiltration. Conclusions: short, frequent home hemodialysis with NSO, on a 6/week-based prescription, allows higher weekly P removal than BHD. With the dialysate Ca concentration in use (6 mg/dL), total plasma Ca and iCa concentration increase is lower in NSO.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Phosphate and Calcium Control in Short Frequent Hemodialysis with the NxStage System One Cycler: Mass Balance Studies and Comparison with Standard Thrice-Weekly Bicarbonate Dialysis

Brunati¹,

Gervasi

Casati³

et al. 2018

Blood Purif

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“…Recent studies suggest that a DCa in the middle of 2.5 and 3.0 mEq/L might be preferable because it gives a mildly positive CaMB, maintains normal SCa and does not stimulate short-term PTH secretion during dialysis [37]. In a more recent study, Waniewski et al [38] observed a mean weekly dialytic removal of 12.8 mmol Ca in 17 patients and a net absorption of 9.5 mmol/week in 8 patients with a DCa of 2.7 mEq/L.…”

Section: Camb In Hemodialysismentioning

confidence: 99%

Dialysate Calcium Levels: Do They Matter?

et al. 2018

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Background: Calcium (Ca) is an essential element that plays a critical role in many biological processes. In dialysis patients, the regulation of Ca balance is highly complex, given the absence of kidney function, endocrine disturbances and the use of drugs such as phosphate binders, vitamin D analogues, and calcimimetics. Also, the use of different dialysate Ca (DCa) baths has profound effect on Ca balance, which depends both on the difference between the Ca concentration in the bath and the serum of the patients, as on the ultrafiltration volume. Summary: The choice of DCa may have important short- and long-term consequences. While lower DCa (especially < 2.5 mEq/L) concentrations have been associated with an increased risk of sudden cardiac death in observational studies, DCa in the higher ranges (3.0 mEq/L and above) may contribute to vascular pathology. Intra-dialytic hemodynamics may also be affected by the choice of DCa. In general, lower DCa concentrations are associated with an increase, and higher DCa concentrations with a decrease in parathyroid hormone (PTH) levels. Preliminary data has suggested that a DCa of 2.75 mEq/L may help in obtaining a net zero intradialytic Ca balance in individual patients, but clinical experience is still limited. Key Message: The optimal Ca balance depends on multiple parameters including blood Ca levels, PTH and the use of phosphate binders and vitamin D analogues, as well as on the risk of hemodynamic stability and cardiac arrhythmias. Therefore, DCa prescription should be individualised. A DCa of 2.75 mEq/L may be useful adjunct for dialysis providers.

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“…Furthermore, when considering calcium clearance during extracorporeal therapies, changes in serum bicarbonate, pH, and magnesium homeostasis have to be considered. Recently proposed novel calcium kinetic models might prove to be helpful toward a more accurate assessment of calcium balance on HD …”

Section: The Choice Of Dca In Conventional Hdmentioning

confidence: 99%

“…Recently proposed novel calcium kinetic models might prove to be helpful toward a more accurate assessment of calcium balance on HD. [13][14][15] Compelling evidence suggests that calcium mass balance is always positive with a DCa 3.5 mEq/L, negative or neutral with the use of mildly positive calcium balance while maintains optimal serum calcium and PTH levels. 26 Variable calcium balances with the same DCa that have been reported in different studies obviously are accounted for by the variability in baseline serum ionized calcium concentration and the ultrafiltrate volume, but probably also by differences in population characteristics as well.…”

Section: The Choi Ce Of D C a In Conventional Hdmentioning

confidence: 99%

Calcium balance in hemodialysis: More uncertainty than certainty

Kirmizis

Basile

2020

Seminars in Dialysis

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There is controversy about the choice of dialysate calcium concentration (DCa), with strong arguments both in favor of and against the use of a low or high DCa, as they can both be potentially harmful. Evidence suggests that calcium mass balance is positive with a DCa 3.5 mEq/L, negative or neutral with the use of DCa 2.5 mEq/L, whereas both positive and negative balances have been observed with the use of DCa 3.0 mEq/L. Overall, the use of DCa >2.5 mEq/L is usually associated with an increase in serum calcium level and a decrease in serum PTH level and use of lower vitamin D analogue dose, with the opposite effects usually observed with the use of lower DCa. Most of the available evidence is from small‐sized and crossover studies; hence, evidence should be regarded with caution and applied in a patient‐specific manner. As there are a lot of significant unanswered questions regarding calcium balance and the optimal DCa in hemodialysis patients, further high‐quality research is needed to clarify many still unclear aspects of calcium homeostasis and balance in these patients. In conclusion, with the existing evidence the choice of DCa needs to be individualized and contextualized in the setting of each patient's calcium balance needs and homeostatic response, taking also into account oral calcium intake (dietary and medicinal), any other relevant therapy administered, such as vitamin D analogues, the type of renal mineral bone disorder, and associated cardiovascular comorbidity.

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Quantification of Dialytic Removal and Extracellular Calcium Mass Balance during a Weekly Cycle of Hemodialysis

Cited by 17 publications

References 34 publications

Phosphate and Calcium Control in Short Frequent Hemodialysis with the NxStage System One Cycler: Mass Balance Studies and Comparison with Standard Thrice-Weekly Bicarbonate Dialysis

Phosphate and Calcium Control in Short Frequent Hemodialysis with the NxStage System One Cycler: Mass Balance Studies and Comparison with Standard Thrice-Weekly Bicarbonate Dialysis

Dialysate Calcium Levels: Do They Matter?

Calcium balance in hemodialysis: More uncertainty than certainty

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