title: Biological impact of targeted dialysate calcium changes in haemodialysis patients: the key role of parathyroid hormone.
abstract: BACKGROUND
  Establishing an optimal dialysate calcium (DCa) concentration in haemodialysis patients is crucial. DCa individualization has been advocated but most dialysis centres use a fixed DCa, preferably 1.25 mmol/L in the USA and 1.5 mmol/L in European countries. The aim of the study was to assess the short-term biological impact of individual DCa prescription aiming at maintaining normal serum calcium and serum parathyroid hormone (PTH) between 150 and 300 pg/mL.
  
  
  METHODS
  Between January 2008 and December 2010, all prevalent patients were checked for the need for DCa change according to our usual strategy. Baseline (T0) and after 3 months (T3), values were compared for serum calcium, phosphate, total alkaline phosphatases (t-ALP) and PTH.
  
  
  RESULTS
  Seventy-eight patients were followed up for analysis with only one DCa change. Vitamin D derivatives, oral calcium and cinacalcet doses remained stable. Increasing DCa from 1.25 to 1.5 mmol/L and from 1.5 to 1.75 mmol/L led to a significant increase of calcaemia (+2.2 and +1.7%) and a decrease of phosphataemia (-7 and -9%), t-ALP (-10 and -12%) and PTH (-50 and -62%). Decreasing DCa from 1.75 to 1.5 mmol/L and from 1.5 to 1.25 mmol/L led to a decrease of calcaemia (-2.5 and -1.7%) and an increase of phosphataemia (+11 and +12%), t-ALP (+12 and +10%) and PTH (+138 and +175%).
  
  
  CONCLUSIONS
  DCa individualization has a significant impact on mineral metabolism parameters, especially on serum PTH levels, and could be considered as an additional therapy in a more global strategy together with phosphate binder, vitamin D and calcimimetics prescription.
authors: NephroCare Tassin-Charcot, Sainte Foy-Les-Lyon, France. guillaume-jean-crat@wanadoo.fr
authors: Guillaume
authors: G
authors: Jean
authors: Brice
authors: B
authors: Mayor
authors: Jean-Marc
authors: JM
authors: Hurot
authors: Patrik
authors: P
authors: Deleaval
authors: Christie
authors: C
authors: Lorriaux
authors: Eric
authors: E
authors: Zaoui
authors: Charles
authors: C
authors: Chazot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood*; D002118:Calcium / Q000032:analysis* / Q000097:blood; D015314:Dialysis Solutions / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D015314:Dialysis Solutions; D010281:Parathyroid Hormone; D010710:Phosphates; D000469:Alkaline Phosphatase; D002118:Calcium