title: Individualizing the dialysate calcium concentration.
abstract: OBJECTIVE
  The optimal dialysate calcium concentration (DCC) in hemodialysis patients is still debated. Strategies have varied over time due to developments in the treatments available for mineral metabolism disorders and our increasing knowledge of bone and vascular diseases. International recommendations [Kidney Disease Outcomes Quality Initiative (KDIGO) and European Best Practice Guidelines] urge for DCC individualization in order to meet the patient's specific needs whenever possible. In this review, we aim to discuss the pros and cons of individualizing the DCC in hemodialysis patients.
  
  
  RESULTS
  Different regions of the world have various strategies with respect to DCCs. Decreasing the DCC slightly reduces calcemia, but mainly stimulates parathyroid hormone secretion and bone turnover. Conversely, increasing the DCC increases calcemia slightly and reduces parathyroid hormone secretion and bone turnover markedly. Furthermore, higher DCCs favor hemodynamic stability and can prevent ventricular arrhythmias. The impact of DCC individualization on survival rate or cardiovascular calcification progression has not been evaluated.
  
  
  CONCLUSIONS
  Individualizing DCC appears to be useful but requires time, a clear defined strategy, and close biological monitoring. Even though some studies have shown that using individualized DCCs of 1.25 or 1.75 mmol/l is not harmful, the real benefits of this strategy need to be assessed in a large, multicentric trial.
authors.affiliation: NEPHROCARE Tassin-Charcot, Haemodialysis and Nephrology, Sainte Foy-les-Lyon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
authors.forename: Charles
authors.initials: C
authors.lastname: Chazot
mesh_terms: D002118:Calcium / Q000378:metabolism*; D015312:Hemodialysis Solutions / Q000378:metabolism*; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy / Q000378:metabolism*; D008903:Minerals / Q000378:metabolism*; D010281:Parathyroid Hormone / Q000378:metabolism / Q000627:therapeutic use; D010710:Phosphates / Q000378:metabolism*; D006435:Renal Dialysis / Q000379:methods
chemical_list: D015312:Hemodialysis Solutions; D008903:Minerals; D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium