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      Intradialytic Calcium Balances with Different Calcium Dialysate Levels

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          It has been shown that calcium carbonate (CaCO<sub>3</sub>) is an effective phosphate binder which is less toxic than Al(OH)<sub>3</sub>. However, given that its use with standard calcium dialysate (CaD) levels may lead to hypercalcemia, a decrease in CaD levels has been proposed. The aim of the present study was to evaluate the acute clinical and biochemical consequences of a lowering of CaD in HD patients. Dialysate composition was otherwise the same. (1) Blood pressure levels (BP) during short hemodialysis were measured in a group of 12 patients who underwent alternate hemodialyses with dialysate calcium of 1.75 and 1.25 mmol/l. (2) Ca<sup>2+</sup> and PTH kinetics during short hemodialysis were studied in a group of 6 patients who were sequentially treated with 1.75 and 1.25 mmol/l CaD. The results show: (1) that cardiovascular stability in chronic HD patients during short HD sessions with low CaD (LCaD) may be good; (2) that a single treatment with standard CaD (SCaD) produces positive calcium balances (JCa<sup>2+</sup>) with Ca<sup>2+</sup> plasma increase and PTHi inhibition at the end of HD sessions; during HD with LCaD there were neutral mean JCa<sup>2+</sup> and no changes in post-dialysis mean Ca<sup>2+</sup> and PTHi plasma levels; furthermore 2 patients showed a small PTHi increase during HD with LCaD and neutral JCa<sup>2+</sup> because of a high positive bicarbonate balance during HD. In conclusion, as with several aspects of dialysis treatment, dialysate calcium levels should also be individualized to avoid hypercalcemic crises or PTHi stimulation.

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          Author and article information

          S. Karger AG
          18 December 2008
          : 72
          : 4
          : 530-535
          Nephrology Department, Hospital, Lecco, Italy
          188934 Nephron 1996;72:530–535
          © 1996 S. Karger AG, Basel

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          Pages: 6
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