What Is Hypercalcemia? The Importance of Fasting Samples

Siyam, Fadi; Klachko, David M.

doi:10.1159/000355526

Cited by 14 publications

(11 citation statements)

References 54 publications

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“…The majority of participants had baseline corrected calcium levels within the normal reference range, i.e. 8.6–10.2 mg/dL (2.15–2.55 mmol/L) 14 . Only 1.1% and 7.4% of participants had hypo- and hypercalcemia, respectively.…”

Section: Resultsmentioning

confidence: 99%

Lower serum calcium is independently associated with CKD progression

Janmaat

Diepen

Gasparini

et al. 2018

Sci Rep

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Disturbances in calcium metabolism are common in individuals with chronic kidney disease (CKD), but whether they are associated with subsequent kidney function decline is less clear. In a CKD 3–5 cohort of 15,755 adult citizens of Stockholm with creatinine tests taken during 2006–2011 and concurrent calcium testing at cohort entry, we investigated the association between baseline serum calcium and the subsequent change in estimated glomerular filtration rate (eGFR, by CKD-EPI) decline using linear mixed models. Mean (SD) baseline corrected serum calcium was 9.6 (0.5) mg/dL. Mean (95%-confidence interval [CI]) eGFR decline was −0.82 (−0.90; −0.74) mL/min/1.73 m2/year. In advanced CKD stages, higher baseline serum calcium was associated with less rapid kidney function decline. The adjusted change (95%-CI) in eGFR decline associated with each mg/dL increase in baseline serum calcium was −0.10 (−0.28; 0.26), 0.39 (0.07; 0.71), 0.34 (−0.02; 0.70) and 0.68 (0.36; 1.00) mL/min/1.73 m2/year for individuals in CKD stage 3a, 3b, 4, and 5, respectively. In a subgroup of patients using vitamin D supplements, the association between baseline serum calcium and CKD progression was eliminated, especially in CKD stage 3b and 4. To conclude, in individuals with CKD stage 3b to 5, lower baseline corrected serum calcium, rather than higher baseline serum calcium, associated with a more rapid CKD progression. Lower serum corrected calcium seems to be indicative for vitamin D deficiency.

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Section: Resultsmentioning

confidence: 99%

Lower serum calcium is independently associated with CKD progression

Janmaat

Diepen

Gasparini

et al. 2018

Sci Rep

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“…First, we measured the ionized calcium levels immediately after drawing the samples, which is in sharp contrast to the previous study 6 . Ionized calcium levels vary easily due to CO 2 changes in the samples 43,44 . Fresh samples are required to measure these levels accurately.…”

Section: Discussionmentioning

confidence: 99%

Hidden Hypocalcemia as a Risk Factor for Cardiovascular Events and All-Cause Mortality among Patients Undergoing Incident Hemodialysis

Yamaguchi

Hamano

Doi

et al. 2020

Sci Rep

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Lower corrected calcium (cca) levels are associated with a better prognosis among incident dialysis patients. However, cca frequently overestimates ionized calcium (ica) levels. the prognostic importance of the true calcium status defined by iCa remains to be revealed. We conducted a retrospective cohort study of incident hemodialysis patients. We collected data of iCa levels immediately before the first dialysis. We divided patients into three categories: apparent hypocalcemia (low ica; <1.15 mmol/L and low cCa; <8.4 mg/dL), hidden hypocalcemia (low iCa despite normal or high cca), and normocalcemia (normal ica). the primary outcome was the composite of all-cause death and cardiovascular diseases after hospital discharge. Among the enrolled 332 patients, 75% of the patients showed true hypocalcemia, defined as iCa <1.15 mmol/L, 61% of whom showed hidden hypocalcemia. in multivariate cox models including other potential risk factors, true hypocalcemia was a significant risk factor (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.03-5.34), whereas hypocalcemia defined as corrected calcium <8.4 mg/dL was not. Furthermore, hidden hypocalcemia was significantly associated with an increased risk of the outcome compared with normocalcemia (HR, 2.56; 95% CI, 1.11-5.94), while apparent hypocalcemia was not. Patients with hidden hypocalcemia were less likely to receive interventions to correct hypocalcemia, such as increased doses of active vitamin D or administration of calcium carbonate, than patients with apparent hypocalcemia (odds ratio, 0.45; 95% CI, 0.23-0.89). Hidden hypocalcemia was a strong predictor of death and cardiovascular events, suggesting the importance of measuring ica.

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“…An important limitation of this study is that the large size of the dialysis organization may have limited optimal processing needed for measurements of ionized calcium. To optimally measure ionized calcium, samples should be collected and managed anaerobically with complete filling of the blood sampling tube to avoid change in pH resulting from a loss of carbon dioxide (33,34). A closed-tube automation system and analyzers would make serum ionized calcium measurement more reliable in clinical practice.…”

Section: Discussionmentioning

confidence: 99%