A formula to predict corrected calcium in haemodialysis patients

Jain, Arsh K.; Bhayana, Shelly; Vlasschaert, Meghan; House, Andrew A.

doi:10.1093/ndt/gfn186

Cited by 47 publications

(66 citation statements)

References 28 publications

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“…In the present study, iCa was not included in most of the laboratory measurements; instead, we selected adjusted Ca to indicate Ca levels. Although we used the formula that is used most often to adjust Ca, adjusted Ca based on any formula reportedly shows only fair agreement with iCa [13,27]. Therefore, the associations between hypocalcemia and both increased CK and hyperphosphatemia need to be validated in future studies using iCa as an indicator for Ca levels.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Facilitates Hypocalcemia by Exacerbating the Hyperphosphatemic Effect of Muscle Damage in Rhabdomyolysis

Higaki

Tanemoto

Shiraishi

et al. 2015

Nephron

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Background/Aims: Hypocalcemia is an important complication of rhabdomyolysis for which several pathogenic factors, including acute kidney injury (AKI), have been proposed. To gain insight regarding the hypocalcemic roles of AKI in rhabdomyolysis, we retrospectively examined patients with rhabdomyolysis. Methods: Of 28,387 patients admitted to the Department of Internal Medicine, 51 patients met the inclusion criteria for the study. Serum calcium was analyzed based on laboratory data including indicators of AKI, serum creatine kinase (CK) and serum inorganic phosphate (iP). Results: Twenty-two patients (43%) had hypocalcemia. Compared with patients without hypocalcemia, they had a higher prevalence of AKI (82 vs. 55%; p = 0.046), higher levels of peak CK (39,100 ± 50,600 vs. 9,800 ± 11,900 IU/l; p = 0.003) and higher levels of peak iP (1.77 ± 1.10 vs. 1.10 ± 0.35 mmol/l; p = 0.007). Indicators of AKI were correlated with peak CK and peak iP and were not significant variables in the regression analysis for hypocalcemia. Peak CK and peak iP were not correlated with each other. Impaired phosphate use by muscle contributed to the increased iP. Conclusion: These findings indicate that muscle damage is the primary hypocalcemic factor in rhabdomyolysis. AKI facilitated hypocalcemia by exacerbating the hyperphosphatemic effects of muscle damage. Aggressive hydration, which could increase oxygen supply and subsequently repair phosphate use in muscle, might reduce the incidence of hypocalcemia in rhabdomyolysis.

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Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Facilitates Hypocalcemia by Exacerbating the Hyperphosphatemic Effect of Muscle Damage in Rhabdomyolysis

Higaki

Tanemoto

Shiraishi

et al. 2015

Nephron

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“…The following set of evaluations was obtained for each participant before surgery and 0.5, 1, 2, 3, 4, 5, and 6 month(s) postoperatively: height and body weight (measured with the calibrated scale seca mBCA 515), waist circumference measured with an inelastic tape, supplement use, and parameters of vitamin D metabolism (25(OH)D (nmol/L), 1,25(OH) 2 D (pg/mL), intact parathyroid hormone PTHi (pg/mL), and albumin-corrected calcium Ca (mmol/L)) [26]. Secondary hyperparathyroidism (SHPT) was defined as PTHi >65 pg/mL with simultaneous normal values for creatinine, calcium, and inorganic phosphate.…”

Section: Methodsmentioning

confidence: 99%

Vitamin D3 Loading Is Superior to Conventional Supplementation After Weight Loss Surgery in Vitamin D-Deficient Morbidly Obese Patients: a Double-Blind Randomized Placebo-Controlled Trial

et al. 2016

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BackgroundBariatric patients often suffer from vitamin D deficiency (VDD), and both, morbid obesity and VDD, are related to non-alcoholic fatty liver disease. However, limited data are available regarding best strategies for treating VDD, particularly, in bariatric patients undergoing omega-loop gastric bypass (OLGB). Therefore, we examined the efficacy and safety of a forced vitamin D dosing regimen and intervention effects in liver fibrotic patients.MethodsIn this double-blind, randomized, placebo-controlled trial, 50 vitamin D-deficient patients undergoing OLGB were randomly assigned to receive, in the first month postoperatively, oral vitamin D3 (≤3 doses of 100,000 IU; intervention group) or placebo as loading dose (control group) with subsequent maintenance dose (3420 IU/day) in both groups until 6-month visit.ResultsCompared with control group, higher increase of 25(OH)D (67.9 (21.1) vs. 55.7 nmol/L (21.1); p = 0.049) with lower prevalence of secondary hyperparathyroidism (10 vs. 24 %; p = 0.045) was observed in intervention group. No (serious) adverse events related to study medication were found. The loading dose regimen was more effective in increasing 25(OH)D in patients with significant liver fibrosis while this was not the case for conventional supplementation (placebo with maintenance dose) (71.5 (20.5) vs. 22.5 nmol/L (13.8); p = 0.022; n = 14).ConclusionsOur findings indicate that a high vitamin D3 loading dose, in the first month postoperatively, with subsequent maintenance dose is effective and safe in achieving higher vitamin D concentrations in OLGB patients. Unexpectedly, it is more effective in patients with significant liver fibrosis which is of potentially high clinical relevance and requires further investigation.Electronic supplementary materialThe online version of this article (doi:10.1007/s11695-016-2437-0) contains supplementary material, which is available to authorized users.

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“…Calcium measurements were corrected for albumin levels, using the formula (22):

false[C_{Ca} false] = false[0.8 \times false(\begin{matrix} N_{Alb} & M_{Alb} \end{matrix} false) false] + M_{Ca},

where C Ca is corrected calcium, M Ca is measured plasma or serum calcium, N Alb is normal albumin = 4 g/dL, and M Alb is measured plasma or serum albumin.…”

Section: Methodsmentioning

confidence: 99%

Prospective Study of Vitamin D Status at Initiation of Care in Critically Ill Surgical Patients and Risk of 90-Day Mortality*

Quraishi

Bittner

Blum

et al. 2014

Critical Care Medicine

101

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Objectives 1) To characterize vitamin D status at initiation of critical care in surgical ICU patients and 2) to determine whether this vitamin D status is associated with the risk of prolonged hospital length of stay, 90-day readmission, and 90-day mortality. Design Prospective cohort study. Setting A teaching hospital in Boston, MA. Patients Hundred surgical ICU patients. Interventions None. Measurements and Main Results Mean (± SD) serum total 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were 17 ± 8 ng/mL and 32 ± 19 pg/mL, respectively. Mean calculated bioavailable 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were 2.5 ± 2.0 ng/mL and 6.6 ± 5.3 pg/mL, respectively. Receiver- operating characteristic curve analysis demonstrated that all of four vitamin D measures predicted the three clinical outcomes; total 25-hydroxyvitamin D was not inferior to the other measures. Median (interquartile range) hospital length of stay was 11 days (8–19 d). Poisson regression analysis, adjusted for biologically plausible covariates, demonstrated an association of total 25-hydroxyvitamin D with hospital length of stay (incident rate ratio per 1 ng/mL, 0.98; 95% CI, 0.97–0.98). The 90-day readmission and mortality rates were 24% and 22%, respectively. Even after adjustment for biologically plausible covariates, there remained significant associations of total 25-hydroxyvitamin D with readmission (odds ratio per 1 ng/mL, 0.84; 95% CI, 0.74–0.95) and mortality (odds ratio per 1 ng/mL, 0.84; 95% CI, 0.73–0.97). Conclusions Serum 25-hydroxyvitamin D levels within 24 hours of ICU admission may identify patients at high risk for prolonged hospitalization, readmission, and mortality. Randomized trials are needed to assess whether vitamin D supplementation can improve these clinically relevant outcomes in surgical ICU patients.

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A formula to predict corrected calcium in haemodialysis patients

Abstract: The use of our simple new formula should enable more appropriate decision making compared to the conventional formula in the highly complex HD population.

Cited by 47 publications

References 28 publications

Acute Kidney Injury Facilitates Hypocalcemia by Exacerbating the Hyperphosphatemic Effect of Muscle Damage in Rhabdomyolysis

Acute Kidney Injury Facilitates Hypocalcemia by Exacerbating the Hyperphosphatemic Effect of Muscle Damage in Rhabdomyolysis

Vitamin D3 Loading Is Superior to Conventional Supplementation After Weight Loss Surgery in Vitamin D-Deficient Morbidly Obese Patients: a Double-Blind Randomized Placebo-Controlled Trial

Prospective Study of Vitamin D Status at Initiation of Care in Critically Ill Surgical Patients and Risk of 90-Day Mortality*

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