title: Approximation of Corrected Calcium Concentrations in Advanced Chronic Kidney Disease Patients with or without Dialysis Therapy.
abstract: BACKGROUND
  The following calcium (Ca) correction formula (Payne) is conventionally used for serum Ca estimation: corrected total Ca (TCa) (mg/dl) = TCa (mg/dl) + [4 - albumin (g/dl)]; however, it is inapplicable to advanced chronic kidney disease (CKD) patients.
  
  
  METHODS
  1,922 samples in CKD G4 + G5 patients and 341 samples in CKD G5D patients were collected. Levels of TCa (mg/day), ionized Ca(2+) (iCa(2+)) (mmol/l) and other clinical parameters were measured. We assumed the corrected TCa to be equal to eight times the iCa(2+) value (measured corrected TCa). We subsequently performed stepwise multiple linear regression analysis using the clinical parameters.
  
  
  RESULTS
  The following formula was devised from multiple linear regression analysis. For CKD G4 + G5 patients: approximated corrected TCa (mg/dl) = TCa + 0.25 × (4 - albumin) + 4 × (7.4 - pH) + 0.1 × (6 - P) + 0.22. For CKD G5D patients: approximated corrected TCa (mg/dl) = TCa + 0.25 × (4 - albumin) + 0.1 × (6 - P) + 0.05 × (24 - HCO3 (-)) + 0.35. Receiver operating characteristic analysis showed the high values of the area under the curve of approximated corrected TCa for the detection of measured corrected TCa ≥8.4 mg/dl and ≤10.4 mg/dl for each CKD sample. Both intraclass correlation coefficients for each CKD sample demonstrated superior agreement using the new formula compared to the previously reported formulas.
  
  
  CONCLUSIONS
  Compared to other formulas, the approximated corrected TCa values calculated from the new formula for patients with CKD G4 + G5 and CKD G5D demonstrates superior agreement with the measured corrected TCa.
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kaku
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ookawara
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Miyazawa
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Ito
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Hirai
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Hoshino
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Honami
authors.initials: H
authors.lastname: Mori
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Yoshida
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Morishita
authors.affiliation: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tabei
keywords: Acid-base metabolism; Albumin; Calcium; Chronic kidney disease; Phosphate