title: Low calcium peritoneal dialysis solution. Effects on calcium metabolism and bone disease in CAPD patients.
abstract: Calcium carbonate (CaCO3) is an effective phosphate (PO4) binder in uremics, and its use reduces aluminum (AI) intake. By maintaining high serum Ca2+ levels, it decreases serum parathyroid hormone (PTH) levels. Hypercalcemia, however, often limits the dosage. To evaluate the effects of a low Ca2+ peritoneal dialysis solution (PDS; 1.25 mmol/L) on calcium metabolism, the following were studied in continuous ambulatory peritoneal dialysis (CAPD) patients with hypercalcemia (six with high PTH levels, and high turnover bone disease [Group 1], and six with low PTH levels, and low turnover bone disease [Group 2] documented by bone biopsies): 1) serum Ca2+ and PO4 levels; 2) serum PTH levels; 3) serum AI levels; and 4) bone morphology. The follow-up was 12 months. In both groups, within the third month, there was a decrease in serum Ca2+. In Group 2, serum PTH increased, reaching the norm, and in Group 1 it further increased, exceeding the norm. Because in both groups serum Ca2+ was normal, it was possible to give oral CaCO3 (10.5 +/- 2.5 g/day) to control PO4 levels while stopping AI gels. This did not induce any increase in serum Ca2+, whereas serum AI fell significantly. In Group 1, to avoid a further rise of serum PTH, the low Ca2+ PDS was supplemented with calcitriol (mean 3.5 +/- 0.5 microgram/day); this was followed by a reduction in serum PTH with no increase in serum Ca2+ or PO4.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Nephrology and Dialysis Unit, St. Paul's Hospital, Savona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Carozzi
authors.forename: M G
authors.initials: MG
authors.lastname: Nasini
authors.forename: C
authors.initials: C
authors.lastname: Schelotto
authors.forename: P M
authors.initials: PM
authors.lastname: Caviglia
authors.forename: O
authors.initials: O
authors.lastname: Santoni
authors.forename: A
authors.initials: A
authors.lastname: Pietrucci
mesh_terms: D000328:Adult; D000535:Aluminum / Q000097:blood; D001851:Bone Diseases, Metabolic / Q000209:etiology / Q000378:metabolism; D001842:Bone and Bones / Q000378:metabolism / Q000473:pathology; D002118:Calcium / Q000008:administration & dosage* / Q000097:blood / Q000378:metabolism*; D015314:Dialysis Solutions; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D010710:Phosphates / Q000097:blood; D013997:Time Factors
chemical_list: D015314:Dialysis Solutions; D010281:Parathyroid Hormone; D010710:Phosphates; D000535:Aluminum; D002118:Calcium