The Study of Low Calcium Dialysate on Elderly Hemodialysis Patients with Secondary Hypoparathyroidism

Abstract

Objective: The study aimed to study the safety and efficacy of 1.25 mmol/l calcium dialysate on maintenance hemodialysis (MHD) in elderly patients who suffered from secondary hypoparathyroidism. Methods: Eighty-two elderly patients (ages ≥65) who had been in MHD with dialysate calcium at 1.5 mmol/l over 6 months and had 2 consecutive serum intact parathyroid hormone (iPTH) measurements at level below 100 pg/ml were selected and randomized into 2 groups: treatment group (41 patients, with dialysate calcium at 1.25 mmol/l) and control group (41 patients, still with dialysate calcium at 1.5 mmol/l). Both groups were studied for the duration of 12 months. The changes of serum iPTH, calcium, phosphorus, calcium and phosphorus product and other indicators as well as related adverse reactions were recorded at the following time points: before the study and 1, 3, 6 and 12 months into the study. In addition, the intimal media thickness (IMT) of carotid artery and abdominal aorta calcification score (AACS) were measured in the 0, 6 and 12 months during the study. Results: (1) In the treatment group, the levels of serum corrected calcium, phosphorus and calcium-phosphate product began to decline after 1 month and exhibited further decrease 3 months later. Serum iPTH level increased significantly after 1 month into the study and the trend continued. The above markers stabilized after month 6. Compared with pre-study markers, the changes of the above markers were significant after study (p < 0.05). (2) The average IMT and AACS were evidently decreased during the 6 and 12 months of study in the treatment group. There was statistical significance (p < 0.05) when compared with the above indexes of the pre-study and the control group. (3) In the control group, there were no significant differences in above laboratory markers over the 12-month study period. (4) There was no significant difference in the adverse events observed between the 2 groups. Conclusion: Safety of low calcium dialysate (dialysate calcium 1.25 mmol/l) in elderly MHD patients with iPTH <100 pg/ml is good, as well as improving carotid IMT, resistance index and AACS as indexes of vascular calcification in the small study group and warrants further investigation.

Long-term effects of low calcium dialysates on the serum calcium levels during maintenance hemodialysis treatments: A systematic review and meta-analysis

“…Lu et al . 13 showed that the cIMT, the resistance index and the abdominal aortic calcification scores were notably decreased after 6 and 12 months of study in an LCD group (p < 0.05). However, Kim et al .…”

“…Consistent with our meta-analysis, a meta-analysis 22 comparing the long - term (12–24 months) clinical effects in patients undergoing peritoneal dialysis (PD) using a dialysate with a dCa of 1.25 or 1.75 mmol/L showed that the serum total Ca levels were lower in the LCD group (MD, 0.09 mmol/L; 95% CI, 0.05–0.13; p < 0.0001) and that the serum iPTH levels were significantly higher in the LCD group. In addition, three of the included RCTs 11 – 13 showed favorable long-term effects from the use of LCD on the incidence of CVD, as shown in Table 2 . One study group 10 , however, unexpectedly showed a contradictory outcome; in this study, the authors inferred that the increased serum iPTH levels in the LCD group might have influenced the progression of coronary artery calcifications.…”

Effects of the dialysate calcium concentrations and mineral bone disease treatments on mortality in The French Renal Epidemiology and Information Network (REIN) registry

“…Our study was unable to evidence any benefit from the use of 1.25 mmol/L formula probably because of its scarce use with a median percentage per unit below 5%. One randomized study having included patients with parathyroid hormone lower than 2 x normal showed a faster progression of the vascular calcifications in subjects dialyzed with 1.5 mmol/l instead of 1.25 [ 16 ]. Lastly, a North-American study analyzed dialysis centers using a very low dialysate calcium concentration (1.0 mmol/L) and defined a facility level covariate [ 17 ].…”

“…calcifications in subjects dialyzed with 1.5 mmol/l instead of 1.25 [16]. Lastly, a North-American study analyzed dialysis centers using a very low dialysate calcium concentration (1.0 mmol/L) and defined a facility level covariate [17].…”

Low Dialysate Calcium: Between Low Arterial Calcification and Improved Low Bone Turnover

“…The present issue of the Journal, Lu et al [2] investigates the efficacy and safety of low calcium dialysate in hemodialysis patients with serum iPTH lower than 100 pg/ml. Interestingly, calcium concentration of 1.25 mmol/l is found to be associated with improved bone mineral parameters and cardiovascular calcification indexes, such as carotid intima-media thickness and carotid artery and abdominal aorta calcification scores.…”