Effects of Lowering Dialysate Calcium Concentration on Mineral and Bone Disorders in Chronic Hemodialysis Patients: Conversion from 3.0 mEq/L to 2.75 mEq/L.
Selection of a lower dialysate calcium concentration (DCa) can reduce calcium burden and prevent vascular calcification in hemodialysis patients. However, decreased DCa can worsen mineral and bone disorders. This 1-year retrospective observational study evaluated 121 hemodialysis patients at Fukuoka Renal Clinic who underwent conversion of DCa from 3.0 mEq/L to 2.75 mEq/L. The primary outcomes were changes in serum levels of calcium, phosphate, and parathyroid hormone (PTH). The effects of baseline serum calcium and PTH levels on changes in biochemical parameters were also determined. One year after DCa conversion, mean serum calcium level decreased, while serum phosphate, alkaline phosphatase, and PTH concentrations increased. The rate of achievement of target PTH was higher in patients with lower serum PTH level at baseline, while patients with higher baseline serum PTH level tended to exceed the upper limit of the PTH target range. Patients with higher baseline serum calcium concentration showed a greater decrease in serum calcium level and a greater increase in serum PTH level at 1 year. Patients with a lower baseline serum PTH level can benefit from optimal PTH control following conversion of DCa from 3.0 mEq/L to 2.75 mEq/L. However, secondary hyperparathyroidism may be exacerbated in some patients with higher baseline serum calcium (Ca) and PTH levels. These results indicate that an individualized approach can maximize the benefits of Ca unloading after conversion to lower DCa.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan.
Shunsuke
S
Yamada
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Kenji
K
Ueki
Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan.
Masanori
M
Tokumoto
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Takaichi
T
Suehiro
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Fukuoka Renal Clinic, Fukuoka, Japan.
Hiroshi
H
Kimura
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Masatomo
M
Taniguchi
Fukuoka Renal Clinic, Fukuoka, Japan.
Satoru
S
Fujimi
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Takanari
T
Kitazono
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Kazuhiko
K
Tsuruya
D000368:Aged; D000469:Alkaline Phosphatase; D001847:Bone Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D002118:Calcium / Q000032:analysis / Q000097:blood; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry / Q000494:pharmacology; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007564:Japan; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D013223:Statistics as Topic; D061205:Vascular Calcification / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
D015312:Hemodialysis Solutions; D010281:Parathyroid Hormone; D010710:Phosphates; D000469:Alkaline Phosphatase; D002118:Calcium
Chronic kidney disease-mineral and bone disorder; Dialysate calcium concentration; Hemodialysis; Parathyroid hormone; Secondary hyperparathyroidism