Low vs standard calcium dialysate in peritoneal dialysis: differences in treatment, biochemistry and bone histomorphometry. A randomized multicentre study

Sánchez, Carmen; López-Barea, Fernando; Sánchez-Cabezudo, Jesús; Bajo, Auxiliadora; Mate, Alberto; Martínez, Eugenia; Selgas, Rafael

doi:10.1093/ndt/gfh214

Cited by 54 publications

(50 citation statements)

References 16 publications

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“…The calcium-sensing receptor in the parathyroid glands is affected by magnesium, and both hypermagnesemia and severe hypomagnesemia can suppress PTH [28,29,30,31,32]. In dialysis patients, many studies have shown an association between lower dialysate [14,33,34,35] or serum [17,36,37] magnesium and higher PTH. However, similar to our findings, Cho et al [38] and O'Donovan et al [39] also failed to show any association between dialysate magnesium and PTH.…”

Section: Discussionmentioning

confidence: 99%

Hypomagnesemia in Hemodialysis Patients: Role of Proton Pump Inhibitors

Alhosaini¹,

Walter

Singh

et al. 2014

Am J Nephrol

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Background: Recent observations have associated hypomagnesemia with increased risk of cardiovascular morbidity and mortality in hemodialysis patients. Methods: We did a 3-month chart review of 62 chronic hemodialysis patients at a single US hospital. All were dialyzed using a dialysate [Mg] of 0.75-1.0 mEq/l. Patients were divided into two groups: hypomagnesemic (mean predialysis plasma [Mg] <1.5 mEq/l) and non-hypomagnesemic (mean predialysis plasma [Mg] ≥1.5 mEq/l). Results: All patients were male; mean age was 64.3 ± 8.7 years and the majority (73%) diabetic. 24 patients (39%) had hypomagnesemia and 38 (61%) were not hypomagnesemic. There were no significant differences between the two groups in age, diabetes status, blood pressure, duration of dialysis, plasma calcium, phosphorus, albumin, intact parathyroid hormone (PTH), dialysis adequacy (Kt/V), or dietary protein intake (as estimated by normalized protein catabolic rate, nPCR). However, use of proton pump inhibitors (PPIs) was significantly associated with hypomagnesemia (plasma [Mg] 1.48 ± 0.16 mEq/l in the PPI group vs. 1.65 ± 0.26 mEq/l in the non-PPI group, p = 0.007). Adjustment for age, diabetes status, duration of dialysis, plasma albumin, Kt/V, nPCR, and diuretic use did not affect the association between PPI use and hypomagnesemia. Conclusions: Use of PPIs in patients dialyzed using a dialysate [Mg] of 0.75-1.0 mEq/l is associated with hypomagnesemia. We suggest monitoring plasma [Mg] in patients taking PPIs, with discontinuation of the medication if possible and/or adjustment of dialysate [Mg] to normalize plasma [Mg].

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Section: Discussionmentioning

confidence: 99%

Hypomagnesemia in Hemodialysis Patients: Role of Proton Pump Inhibitors

Alhosaini¹,

Walter

Singh

et al. 2014

Am J Nephrol

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“…There is now evidence that hyperparathyroidism, an independent risk factor for vascular calfication, develops in continuous ambulatory peritoneal dialysis (CAPD) patients dialyzed with low-calcium and low-Mg peritoneal dialysis solutions, even though their serum Ca is maintained at a normal level [44,45] . One possible explanation for this is that low Mg functions as a stimulus for PTH secretion independently of serum Ca concentration.…”

Section: Mg In Peritoneal Dialysis Patientsmentioning

confidence: 99%

Magnesium in Chronic Kidney Disease: Challenges and Opportunities

Kanbay¹,

Goldsmith

Uyar

et al. 2010

Blood Purif

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Cardiovascular disease is the leading cause of mortality and morbidity in patients with chronic kidney disease, which is partly explained by the fact that 40–70% of patients receiving dialysis have significant coronary artery disease. Recent clinical studies have shown that lower serum magnesium (Mg) levels are associated with vascular calcification and cardiovascular mortality among patients with end-stage renal disease (ESRD). On the other hand, hypermagnesemia inhibits parathyroid hormone secretion, which is considered an important independent risk factor for vascular calcification, left ventricular hypertrophy and mortality in ESRD patients. Finally, increasing evidence points towards a link between Mg and cardiovascular disease, even in subjects without chronic kidney disease. The purpose of this review was to critically review the current literature examining the effects of plasma Mg levels on cardiovascular disease and parathyroid hormone homeostasis in ESRD, and renal transplant patients.

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“…In continuous ambulatory peritoneal dialysis (CAPD) patients, higher serum ionized calcium concentrations can be found due to the lower albumin levels. In this clinical setting it has been suggested that 1.75 mmol/l calcium dialysate causes calcium uptake [14] while 1.25 mmol/l calcium dialysate shows a negative calcium balance [15] .…”

Section: Calcium Balance In Peritoneal Dialysis (Pd)mentioning

confidence: 99%

Calcium and Phosphate Control by Dialysis Treatments

et al. 2009

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Calcium and phosphate changes, besides their involvement in bone disease, have been claimed to also be involved in the increased vascular morbidity and mortality of dialysis patients. Even after the recent advances of therapeutic options, their control still remains a challenging problem. Dialysis treatment is a basic approach to the control of these two electrolytes. Calcium control by dialysis is mainly dependent on its mass balance, which is variably influenced by the calcium concentration difference between blood and dialysis solutions (either dialysate or infusion fluids) and by the duration of the treatment. There is no full agreement on the ideal calcium concentration in dialysis fluids, since this choice is also mostly influenced by the concomitant medical therapy. However, there is some consensus in suggesting a lower calcium concentration in standard hemodialysis (HD) treatment (1.25–1.50 mmol/l) than in dialysis treatments characterized by high convective transport. In peritoneal dialysis, calcium balance is affected by its blood dialysate concentration difference and dialysate glucose concentration, with ideal calcium concentration probably being >1.25 and <1.75 (which are the most commonly used concentrations). Phosphate dialysis balance is also a critical and challenging problem, since the possibility to reach an always desired null or possibly negative balance relies on this. Even though some increased phosphate removal can be obtained with the highest efficiency techniques, such as hemodiafiltration as compared with traditional HD, the most impacting factor still remains the duration of dialysis treatment. However, some experimental attempts at increasing phosphate removal independently of increasing dialysis duration are mentioned.

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Low vs standard calcium dialysate in peritoneal dialysis: differences in treatment, biochemistry and bone histomorphometry. A randomized multicentre study

Abstract: LCD use for 1 year was associated with an increase in PTH levels, but did not lead to histological changes different from those observed in SCD group. The LCD solution allowed a higher oral intake of calcium salts with a satisfactory control of the serum Calcium-Phosphorus product.

Cited by 54 publications

References 16 publications

Hypomagnesemia in Hemodialysis Patients: Role of Proton Pump Inhibitors

Hypomagnesemia in Hemodialysis Patients: Role of Proton Pump Inhibitors

Magnesium in Chronic Kidney Disease: Challenges and Opportunities

Calcium and Phosphate Control by Dialysis Treatments

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