Anion Gap as a Determinant of Ionized Fraction of Divalent Cations in Hemodialysis Patients

Sakaguchi, Yusuke; Hamano, Takayuki; Kubota, Keiichi; Oka, Tetsushi; Yamaguchi, Satoshi; Matsumoto, Ayumi; Hashimoto, Nozomi; Mori, Daisuke; Obi, Yasue; Matsui, Isao; Isaka, Yoshitaka

doi:10.2215/cjn.07930717

Cited by 32 publications

(25 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypermagnesemia was present in 69% of a group of 118 HD patients based on total magnesium levels but only 13% when based on ionized magnesium values. The ionized fraction of serum magnesium was significantly lower in these patients than in 112 nondialysis patients used as controls (mean, 51% v 63%) …”

mentioning

confidence: 68%

“…The ionized fraction of serum magnesium was significantly lower in these patients than in 112 nondialysis patients used as controls (mean, 51% v 63%). 5 A study of 1102 new HD patients found that those with a resting heart rate >100 beats/min before their initial dialysis (N = 69) had an adjusted all-cause mortality rate 2.3-fold higher than those with a heart rate of 80-100 beats/min. Patients with heart failure, atrial fibrillation, beta blocker use, and other confounders were excluded from the study.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Briefly Noted

Sherman¹

2018

Seminars in Dialysis

View full text Add to dashboard Cite

mentioning

confidence: 68%

mentioning

confidence: 99%

Briefly Noted

Sherman¹

2018

Seminars in Dialysis

View full text Add to dashboard Cite

“…Even very low ionized calcium levels can be asymptomatic in chronic hypocalcemia, and cSCa gradually declines along with kidney function in the later stages of CKD as shown in our study. Also, calcium status may be underestimated in late‐stage CKD because the fraction of ionized calcium increases according to metabolic acidosis . These factors observed in late‐stage CKD may diminish the mortality risk of hypocalcemia, resulting in the incremental association between cSCa and mortality.…”

Section: Discussionmentioning

confidence: 99%

Association of Pre-ESRD Serum Calcium With Post-ESRD Mortality Among Incident ESRD Patients: A Cohort Study

Obi

Park

Soohoo

et al. 2018

Journal of Bone and Mineral Research

Self Cite

View full text Add to dashboard Cite

Albumin-corrected serum calcium (cSCa) decline at late stages of chronic kidney disease and rise after dialysis initiation. Although hypercalcemia is associated with higher mortality in end-stage renal disease (ESRD), there are scarce data on the impact of pre-ESRD cSCa on post-ESRD mortality. Therefore, we used a large national cohort of 21,826 US veterans who transitioned to dialysis in all US Department of Veterans Affairs health care facilities over 2009 to 2014 to examine the associations with all-cause and cause-specific post-ESRD mortality of (1) cSCa concentrations averaged over the last 6 months and (2) its rate of decline during the last 12 months before dialysis initiation. Mean concentrations and median rate of decline of cSCa were 9.3 ± 0.7 mg/dL and -0.15 (interquartile range -0.39 to 0.07) mg/dL/year, respectively. A total of 9596 patients died during the follow-up period (mean 1.9 years; total 41,541 patient-years) with an incidence rate of 23.1 per 100 patient-years. There was an independent linear association between higher cSCa with higher mortality (p < 0.001). The mortality risk associated with cSCa ≥9.0 mg/dL was attenuated among active vitamin D users (p < 0.001). Patients with faster decline in cSCa showed lower mortality irrespective of baseline cSCa concentrations. These cSCa-mortality associations were stronger for noncardiovascular versus cardiovascular death. In conclusion, lower pre-ESRD cSCa and faster decline in cSCa were consistently and linearly associated with better post-ESRD survival among US veterans, especially for noncardiovascular death. Further studies are needed to determine if correcting hypocalcemia is beneficial or harmful and which intervention is preferred when indicated among patients transitioning to ESRD. © 2018 American Society for Bone and Mineral Research.

show abstract

“…Ionized Ca is the ideal measure when assessing serum Ca. It is influenced by alterations in albumin, circulating levels of anions, and acid-base status that are common in dialysis patients [97], and thus may not correlate with total serum Ca. Albumin-corrected Ca is superior to uncorrected total Ca, and should be used to modify treatment if ionized Ca is not available.…”

Section: Evidence and Rationalementioning

confidence: 99%

The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis—clinical practice recommendation from the Pediatric Renal Nutrition Taskforce

et al. 2019

View full text Add to dashboard Cite

In children with chronic kidney disease (CKD), optimal control of bone and mineral homeostasis is essential, not only for the prevention of debilitating skeletal complications and achieving adequate growth but also for preventing vascular calcification and cardiovascular disease. Complications of mineral bone disease (MBD) are common and contribute to the high morbidity and mortality seen in children with CKD. Although several studies describe the prevalence of abnormal calcium, phosphate, parathyroid hormone, and vitamin D levels as well as associated clinical and radiological complications and their medical management, little is known about the dietary requirements and management of calcium (Ca) and phosphate (P) in children with CKD. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists, who develop clinical practice recommendations (CPRs) for the nutritional management of various aspects of renal disease management in children. We present CPRs for the dietary intake of Ca and P in children with CKD stages 2-5 and on dialysis (CKD2-5D), describing the common Ca-and P-containing foods, the assessment of dietary Ca and P intake, requirements for Ca and P in healthy children and necessary modifications for children with CKD2-5D, and dietary management of hypo-and hypercalcemia and hyperphosphatemia. The statements have been graded, and statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.

show abstract

Anion Gap as a Determinant of Ionized Fraction of Divalent Cations in Hemodialysis Patients

Abstract: Anions that accumulate in patients on hemodialysis contribute to the lower ionized fraction of magnesium and calcium. Equations that incorporate the anion gap provide better predictions of ionized magnesium and calcium in patients on hemodialysis.

Cited by 32 publications

References 33 publications

Briefly Noted

Briefly Noted

Association of Pre-ESRD Serum Calcium With Post-ESRD Mortality Among Incident ESRD Patients: A Cohort Study

The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis—clinical practice recommendation from the Pediatric Renal Nutrition Taskforce

Contact Info

Product

Resources

About