Ionized calcium: analytical challenges and clinical relevance

Hamroun, Aghilès; Pekar, Jean‐David; Lionet, Arnaud; Ghulam, Amjad; Maboudou, Patrice; Mercier, Ambroise; Brousseau, Thierry; Grzych, Guillaume; Guilhot, François

doi:10.21037/jlpm-20-60

Cited by 18 publications

(24 citation statements)

References 95 publications

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“…This is based on the important hypothesis that a decrease in albumin leads to a decrease in the albumin-bound calcium fraction which leads to a decrease in total calcium while ionized calcium levels remain normal and such patients remain asymptomatic. 11,20 After correction for hypoalbuminaemia in our study, the cases had normal to increased serum corrected calcium levels. The finding of normal serum corrected calcium in some of the cases is in consonance to the report by Hooft et al who had reported that children with nephrotic syndrome would have had proteinuria for more than 2 months before a decrease in ionized calcium level is found.…”

Section: Discussionmentioning

confidence: 51%

“…Furthermore, current research has shown that unlike the previous hypothesis where a decrease in albumin led to a decrease in the albumin-bound calcium the calcium affinity for albumin has been found to increase significantly when there is hypoalbuminaemia negating the initial hypothesis. 11,20 This may explain the finding of overestimated levels of corrected calcium when correction formulaes are used. 20 Other researchers in an attempt to get the perfect formulae have proposed using PH adjusted formulaes, anion-gap adjusted formulaes, while others concluded that locally derived formulaes or focusing on the mathematical conception of the regression equations as a means of getting a more accurate correction formula.…”

Section: Discussionmentioning

confidence: 99%

“…11,20 This may explain the finding of overestimated levels of corrected calcium when correction formulaes are used. 20 Other researchers in an attempt to get the perfect formulae have proposed using PH adjusted formulaes, anion-gap adjusted formulaes, while others concluded that locally derived formulaes or focusing on the mathematical conception of the regression equations as a means of getting a more accurate correction formula. 20,24,25 Payne had also reminded the academic and research world that the Payne formula was not intended for universal use.…”

Section: Discussionmentioning

confidence: 99%

“…20 Other researchers in an attempt to get the perfect formulae have proposed using PH adjusted formulaes, anion-gap adjusted formulaes, while others concluded that locally derived formulaes or focusing on the mathematical conception of the regression equations as a means of getting a more accurate correction formula. 20,24,25 Payne had also reminded the academic and research world that the Payne formula was not intended for universal use. 26 In actual fact, most of these formulas have not performed better than uncorrected total serum calcium levels.…”

Section: Discussionmentioning

confidence: 99%

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Correlation between corrected serum calcium and serum albumin in children with idiopathic nephrotic syndrome in North central, Nigeria

Aliyu¹,

Mohammed²,

Abdullahi³

2021

Int J Contemp Pediatr

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Background: Nephrotic syndrome is a clinical condition caused by alteration of glomerular membrane permeability resulting in a net loss of protein, and vitamin D binding proteins in urine leading to hypoalbuminaemia and hypocalcaemia. A positive correlation between serum albumin and ionized calcium in childhood nephrotic syndrome has been described but the correlation between total serum calcium or corrected serum calcium and serum albumin has not been extensively described.Methods: This study was carried out at Dalhatu Araf Specialist Hospital, Lafia Nigeria. Fifteen children with idiopathic nephrotic syndrome were recruited consecutively as the cases, 15 age and gender matched healthy children were recruited as the controls. Total serum calcium and albumin was assayed in all these children. Corrected serum calcium was calculated for the cases. Tests of correlation was carried out to see if there was any relationship between corrected or total serum calcium and serum albumin.Results: The mean total serum calcium and serum corrected calcium levels in the cases was 2.04±0.34 mmol/l and 2.5 mmol/l respectively. The mean total serum calcium was 2.12±0.32 mmol/l for the controls. The mean serum albumin level was 14.7±4.1 g/l and 34.6±2.7 mmol/l for the cases and controls respectively. A negative and weak correlation was found between serum albumin and corrected serum calcium and a similar negative correlation between serum albumin and total serum calcium.Conclusions: The common reports of a positive correlation between serum ionized calcium and serum albumin cannot be applied to total or corrected serum calcium and serum albumin.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Correlation between corrected serum calcium and serum albumin in children with idiopathic nephrotic syndrome in North central, Nigeria

Aliyu¹,

Mohammed²,

Abdullahi³

2021

Int J Contemp Pediatr

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“…9 The cT Ca equation was popularized in the 1970s, without validation against I Ca . Subsequent external validation studies, which incorporated I Ca , found the diagnostic performance of cT Ca to be poor, 8,[10][11][12] but by then its routine use in clinical practice had been cemented. Commonly suggested reasons for the poor performance of cT Ca include its failure to account for alterations in the affinity of albumin for calcium caused by changes in pH and free fatty acids in critical care patients, or for the differences among centers in the albumin assay.…”

Section: Introductionmentioning

confidence: 99%

Predicting ionized hypocalcemia: External validation of an ionized calcium prediction model in patients with COVID-19 and renal failure

et al. 2021

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Background Ionized hypocalcemia is common in critically ill patients with COVID-19 and is associated with adverse outcomes. We previously developed a linear model that estimates ionized calcium (ICa) by adjusting total calcium (TCa) for the three components of the anion gap and albumin. On internal validation, it outperformed the popular method that corrects TCa for albumin alone (cTCa) in diagnosing low ICa. In this study, we sought to externally validate our ICa model in hospitalized COVID-19 positive patients. Methods We retrospectively studied all 200 patients with COVID-19 who were admitted to the State University of New York Downstate Medical Center between March 11th and April 30th 2020 and referred to the nephrology service for renal failure, and who had ICa measured on a venous blood gas within 25 min of a comprehensive metabolic panel. We compared the performance of the ICa model and cTCa in diagnosing low ICa by ROC analysis, and also examined the accuracy of the absolute values predicted by the two methods relative to measured ICa. Results On ROC analysis, the ICa model was better than cTCa (area under ROC curve: 0.872 [0.025] vs. 0.835 [0.028]; p = 0.045). The ICa model estimated ICa accurately, but the cTCa method seemed to overcorrect TCa, as a substantial number of patients with clearly normal cTCa values had low ICa. Conclusions In an external validation cohort, the ICa model estimated ICa accurately and was better than cTCa in the diagnosis of low ICa. This finding can be useful in guiding direct ICa testing.

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The effect of ionic redistributions on the microwave dielectric response of cytosol water upon glucose uptake

Galindo,

Livshits,

Tarabeih

et al. 2024

Eur Biophys J

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Ionized calcium: analytical challenges and clinical relevance

Cited by 18 publications

References 95 publications

Correlation between corrected serum calcium and serum albumin in children with idiopathic nephrotic syndrome in North central, Nigeria

Correlation between corrected serum calcium and serum albumin in children with idiopathic nephrotic syndrome in North central, Nigeria

Predicting ionized hypocalcemia: External validation of an ionized calcium prediction model in patients with COVID-19 and renal failure

The effect of ionic redistributions on the microwave dielectric response of cytosol water upon glucose uptake

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