Optimizing the dialysate calcium concentration in bicarbonate haemodialysis

Bosticardo, Gianmario; Malberti, Fabio; Basile, Carlo; Leardini, Loretta; Libutti, Pasquale; Filiberti, Oliviero; Schillaci, Enrico; Ravani, Pietro

doi:10.1093/ndt/gfr733

Cited by 31 publications

(31 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Current guidelines [55] recommend the use of a dCa concentration of 1.25 to 1.5 mmol/l in both HD and PD patients. However a recent study [56] showed that the intradialytic Ca mass balance was nearly neutral using a dCa of 1.25 mmol/l, whereas treatment with a dCa of 1.50 mmol/l resulted in gain of Ca during HD. dCa concentrations as high as 1.75 mmol/l should be avoided to prevent calcium overload and the induction of adynamic bone disease.…”

Section: Discussionmentioning

confidence: 95%

The Role of Serum Magnesium and Calcium on the Association between Adiponectin Levels and All-Cause Mortality in End-Stage Renal Disease Patients

Markaki

Kyriazis²,

Stylianou

et al. 2012

PLoS ONE

View full text Add to dashboard Cite

BackgroundAdiponectin (ADPN) is the most abundant adipocyte-specific cytokine that plays an important role in energy homeostasis by regulating lipid and glucose metabolism. Studies of the impact of ADPN on clinical outcomes have yielded contradictory results so far. Here, we examined the association of ADPN with serum magnesium (s-Mg) and calcium (s-Ca) levels and explored the possibility whether these two factors could modify the relationship between ADPN and all-cause mortality in patients with end-stage renal disease.Methodology/Principal FindingsAfter baseline assessment, 47 hemodialysis and 27 peritoneal dialysis patients were followed- up for a median period of 50 months. S-Mg and s-Ca levels emerged as positive and negative predictors of ADPN levels, respectively. During the follow-up period 18 deaths occurred. There was a significant 4% increased risk for all-cause mortality for each 1-µg/ml increment of ADPN (crude HR, 1.04; 95% CI, 1.01–1.07), even after adjustment for s-Mg and s-Ca levels, dialysis mode, age, albumin and C-reactive protein. Cox analysis stratified by s-Mg levels (below and above the median value of 2.45 mg/dl) and s-Ca levels (below and above the median value of 9.3 mg/dl), revealed ADPN as an independent predictor of total mortality only in the low s-Mg and high s-Ca groups. Furthermore, low s-Mg and high s-Ca levels were independently associated with malnutrition, inflammation, arterial stiffening and risk of death.Conclusions/SignificanceThe predictive value of ADPN in all-cause mortality in end-stage renal disease patients appears to be critically dependent on s-Mg and s-Ca levels. Conversely, s-Mg and s-Ca may impact on clinical outcomes by directly modifying the ADPN’s bioactivity.

show abstract

Section: Discussionmentioning

confidence: 95%

The Role of Serum Magnesium and Calcium on the Association between Adiponectin Levels and All-Cause Mortality in End-Stage Renal Disease Patients

Markaki

Kyriazis²,

Stylianou

et al. 2012

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Very few incongruent studies on intradialysis CaMB have been published so far . The inconsistencies found in these studies can be explained by the chosen method of CaMB estimation.…”

Section: Discussionmentioning

confidence: 99%

Assessment of intradialysis calcium mass balance by a single pool variable‐volume calcium kinetic model

Filippo

Carfagna

Milia

et al. 2017

Hemodialysis International

View full text Add to dashboard Cite

Introduction: A reliable method of intradialysis calcium mass balance quantification is far from been established. We herein investigated the use of a single-pool variable-volume Calcium kinetic model to assess calcium mass balance in chronic and stable dialysis patients.Methods: Thirty-four patients on thrice-weekly HD were studied during 240 dialysis sessions. All patients were dialyzed with a nominal total calcium concentration of 1.50 mmol/L. The main assumption of the model is that the calcium distribution volume is equal to the extracellular volume during dialysis. This hypothesis is assumed valid if measured and predicted end dialysis plasma water ionized calcium concentrations are equal. A difference between predicted and measured end-dialysis ionized Correspondence to: S. Di Filippo, Division of Nephrology, A. Manzoni Hospital, Via dell'Eremo 9/11, 23900 Lecco, Italy. Email: difilippo.salvatore@libero.it Conflict of Interest: The Authors have nothing to disclose with regards of the present manuscript. Disclosure of grants or other funding: None List of abbreviations: 0-t, Initial and final values; Ca21d, Ionized dialysate calcium concentrations (mmol/L); Ca21di, Dialysate calcium concentration (mmol/L) at the inlet port of dialyzer; Ca21MB, Intra-dialysis ionized calcium mass balance (mmol); Ca21pw, Ionized plasma water calcium concentrations (mmol/L); Ca21pwi, Plasma water calcium concentration (mmol/L) at the inlet port of dialyzer; Ca21pwtM, End-dialysis measured plasma water calcium concentration (mmol/L) normalized at pH 7.40; Ca21pwtP, End-dialysis plasma water calcium concentration (mmol/L) predicted by the model; Ca21pwt(P-M), Difference between end-dialysis plasma water calcium concentration predicted and measured (mmol/L); Ca21uf, Outlet ultrafiltrate stream calcium concentration (mmol/L) normalized at pH 7.40; CaMB, Intra-dialysis global calcium mass balance (mmol); D 0 Ca, Calcium dialysance (L/min) corrected for cardiopulmonary and access recirculation; D 0 cond, Conductivity dialysance (L/ min) corrected for cardiopulmonar and access recirculation; KoAcond, "Intrinsic" dialysance for conductivity (mL/min); MCa21, Mobilization of calcium from extracellular fluid compartment (mmol); Na1d, Ionized dialysate sodium concentrations (mmol/L); Na1pw, Ionized plasma water sodium concentrations (mmol/L); Qbi, Inlet blood flow (mL/min); Qei, Inlet blood water flow (mL/min); Qdi, Inlet dialysate flow (mL/min); Cdi, Inlet dialysate conductivity (mS/cm); Qf, Total ultrafiltrate (L); QfECW, Ultrafiltrate removed from the extracellular fluid compartment (L/min); Qpwi, Inlet plasma water flow (L/min); SPVVCaKM, Single-compartment variable-volume calcium kinetic model; SPVV-NaKM, Single-compartment variable-volume sodium kinetic model; Td, Dialysis session duration (min); VCat, End-dialysis calcium distribution volume (L); Vut, End dialysis urea distribution volume (L); spKt/V, Single Pool Kt/V; a, Donnan factor Predialysis ionized plasma water concentration and total ultrafiltrate were the most imp...

show abstract

“…Although individualization has been advocated, most centers use established dialysate calcium concentrations within the recommended range. In bicarbonate hemodialysis, calcium mass balance studies showed net positive transfer of Ca from dialysate to blood with 1.5 mmol/L and approximately neutral or slightly negative Ca flux with 1.25 mmol/L dialysate Ca in most patients [17]. However, the main driving force responsible for calcium mass balance is diffusion gradient between ionized Ca in the blood and dialysate and ultrafiltration.…”

Section: Discussionmentioning

confidence: 99%

Changes of Serum Calcium, Magnesium and Parathyroid Hormone Induced by Hemodialysis with Citrate-Enriched Dialysis Solution

Šafránek¹,

Moučka²,

Vávrová³

et al. 2015

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: In recent years, one of technical attempts to improve biocompatibility and tolerability of the hemodialysis procedure is the substitution of acetate in dialysis solution with citrate. The aim of our study was to compare two dialysis solutions: traditional bicarbonate dialysis solution containing acetate (3 mmol/L) (solution A); and (solution C) commercially produced citrate-enriched bicarbonate dialysis solution (0.8 mmol/L citrate). Methods: Patients from a single hemodialysis center (N=126) were included in the study. Both conventional low-flux hemodialysis and on-line hemodiafiltration procedures were studied. Both dialysis solutions contained identical calcium (1.5 mmol/L) and magnesium (0.5 mmol/L) concentrations. Results: Parathyroid hormone (iPTH) concentration decreased during procedures with solution A by 64%. On the contrary, when solution C was used, iPTH concentration increased insignificantly by 4%. For solution A, serum calcium and magnesium increased during procedures in patients with predialysis concentrations lower than 2.33 and 0.76 mmol/L, respectively. In procedures with dialysis solution C these concentrations were significantly lower: 2.19 mmol/L for Ca and 0.68 mmol/L for Mg. Conclusion: Our study clearly shows that the substitution of part of acetate with citrate in dialysis solution significantly influences changes of serum calcium, magnesium and parathyroid hormone concentrations during hemodialysis and hemodiafiltration procedures.

show abstract

Optimizing the dialysate calcium concentration in bicarbonate haemodialysis

Abstract: While CMB is nearly neutral when using 1.25 DCa, the use of 1.5 DCa results in a gain of Ca during HD. The risks associated with Ca load should be considered in the choice of DCa prescription for HD but need also be weighed against the risk of worse haemodynamic dialysis tolerance.

Cited by 31 publications

References 26 publications

The Role of Serum Magnesium and Calcium on the Association between Adiponectin Levels and All-Cause Mortality in End-Stage Renal Disease Patients

The Role of Serum Magnesium and Calcium on the Association between Adiponectin Levels and All-Cause Mortality in End-Stage Renal Disease Patients

Assessment of intradialysis calcium mass balance by a single pool variable‐volume calcium kinetic model

Changes of Serum Calcium, Magnesium and Parathyroid Hormone Induced by Hemodialysis with Citrate-Enriched Dialysis Solution

Contact Info

Product

Resources

About