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      Hypercalcaemia, Hypermagnesaemia, Hyperphosphataemia and Hyperaluminaemia in CAPD: Improvement in Serum Biochemistry by Reduction in Dialysate Calcium and Magnesium Concentrations

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          Abstract

          Phosphate binders are necessary to control hyperphosphataemia in the majority of dialysis patients. Whilst aluminium salts are efficient phosphate binders, their use is associated with toxic side effects. Calcium salts are a widely used alternative, but hypercalcaemia is a common side effect, limiting their use and raising concern about metastatic calcification. Reduction of the dialysis fluid calcium concentration has been shown to reduce hypercalcaemia in haemodialysis patients, with an associated decrease in serum PTH. We analysed the effect of reduced calcium/magnesium (1.25/0.25 mmol/l), 40 mmol/l lactate, PD fluid (PD4) on 11 CAPD patients with uncontrollable hypercalcaemia ( > 2.65 mmol/l) and hyperphosphataemia ( > 1.80 mmol/l). Only 1 patient remained hypercalcaemic, while phosphate fell in 6 patients (2.23 ± 0.16 on no binder, to 1.68 ± 0.08 mmol/l at 6 months (p < 0.05), but was unchanged in 5 (2.10 ± 0.15 to 2.48 ± 0.14 mmol/l [p = NS]). Overall mean calcium × phosphate product changed little. However, in a subgroup it fell significantly (p < 0.05). Geometric mean iPTH rose, but not significantly. The subgroup of patients whose calcium × phosphate product fell, exhibited a much smaller rise in iPTH than the others (57.3-73.2 vs. 52.8-167.1 pg/ml). 1.25-Dihydroxyvitamin D<sub>3</sub> was subnormal in all patients. Mean serum magnesium fell from 1.24 ± 0.06 to 0.89 ± 0.04 mmol/l (p < 0.001), whilst mean serum bicarbonate rose significantly (25.2 ± 0.4 to 28.9 ± 1.2 mmol/l;p < 0.01). Withdrawal of aluminium-containing phosphate binders resulted in mean serum aluminium falling significantly from 31.1 ± 5.7 at start of PD4 to 15.4 ± 2.7 µg/l at 6 months (p < 0.05). In summary, in around 50% of CAPD patients with persistent hypercalcaemia and hyperphosphataemia, reduction in PD fluid calcium can produce significant improvement in phosphate, reduction of calcium × phosphate product, and enable avoidance of aluminium-containing phosphate binders. Patients whose calcium and phosphate control remains poor, still benefit from the reduction, or cessation, of oral aluminium intake.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1996
          1996
          18 December 2008
          : 72
          : 1
          : 52-58
          Affiliations
          aRenal Dialysis Unit, and bDepartment of Biochemistry, Manchester Royal Infirmary, and cDepartment of Medicine, University of Manchester, UK
          Article
          188806 Nephron 1996;72:52–58
          10.1159/000188806
          8903861
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          Original Paper

          Cardiovascular Medicine, Nephrology

          Phosphate, Calcium carbonate, Hypercalcaemia, CAPD

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