TY - JOUR
T1 - Effects of Lowering Dialysate Calcium Concentration on Mineral and Bone Disorders in Chronic Hemodialysis Patients
T2 - Conversion from 3.0mEq/L to 2.75mEq/L
AU - Yamada, Shunsuke
AU - Ueki, Kenji
AU - Tokumoto, Masanori
AU - Suehiro, Takaichi
AU - Kimura, Hiroshi
AU - Taniguchi, Masatomo
AU - Fujimi, Satoru
AU - Kitazono, Takanari
AU - Tsuruya, Kazuhiko
N1 - Publisher Copyright:
© 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Selection of a lower dialysate calcium concentration (DCa) can reduce calcium burden and prevent vascular calcification in hemodialysis patients. However, decreased DCa can worsen mineral and bone disorders. This 1-year retrospective observational study evaluated 121 hemodialysis patients at Fukuoka Renal Clinic who underwent conversion of DCa from 3.0mEq/L to 2.75mEq/L. The primary outcomes were changes in serum levels of calcium, phosphate, and parathyroid hormone (PTH). The effects of baseline serum calcium and PTH levels on changes in biochemical parameters were also determined. One year after DCa conversion, mean serum calcium level decreased, while serum phosphate, alkaline phosphatase, and PTH concentrations increased. The rate of achievement of target PTH was higher in patients with lower serum PTH level at baseline, while patients with higher baseline serum PTH level tended to exceed the upper limit of the PTH target range. Patients with higher baseline serum calcium concentration showed a greater decrease in serum calcium level and a greater increase in serum PTH level at 1 year. Patients with a lower baseline serum PTH level can benefit from optimal PTH control following conversion of DCa from 3.0mEq/L to 2.75mEq/L. However, secondary hyperparathyroidism may be exacerbated in some patients with higher baseline serum calcium (Ca) and PTH levels. These results indicate that an individualized approach can maximize the benefits of Ca unloading after conversion to lower DCa.
AB - Selection of a lower dialysate calcium concentration (DCa) can reduce calcium burden and prevent vascular calcification in hemodialysis patients. However, decreased DCa can worsen mineral and bone disorders. This 1-year retrospective observational study evaluated 121 hemodialysis patients at Fukuoka Renal Clinic who underwent conversion of DCa from 3.0mEq/L to 2.75mEq/L. The primary outcomes were changes in serum levels of calcium, phosphate, and parathyroid hormone (PTH). The effects of baseline serum calcium and PTH levels on changes in biochemical parameters were also determined. One year after DCa conversion, mean serum calcium level decreased, while serum phosphate, alkaline phosphatase, and PTH concentrations increased. The rate of achievement of target PTH was higher in patients with lower serum PTH level at baseline, while patients with higher baseline serum PTH level tended to exceed the upper limit of the PTH target range. Patients with higher baseline serum calcium concentration showed a greater decrease in serum calcium level and a greater increase in serum PTH level at 1 year. Patients with a lower baseline serum PTH level can benefit from optimal PTH control following conversion of DCa from 3.0mEq/L to 2.75mEq/L. However, secondary hyperparathyroidism may be exacerbated in some patients with higher baseline serum calcium (Ca) and PTH levels. These results indicate that an individualized approach can maximize the benefits of Ca unloading after conversion to lower DCa.
KW - Chronic kidney disease-mineral and bone disorder
KW - Dialysate calcium concentration
KW - Hemodialysis
KW - Parathyroid hormone
KW - Secondary hyperparathyroidism
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U2 - 10.1111/1744-9987.12329
DO - 10.1111/1744-9987.12329
M3 - Article
C2 - 26482334
AN - SCOPUS:84958121718
SN - 1744-9979
VL - 20
SP - 31
EP - 39
JO - Therapeutic Apheresis and Dialysis
JF - Therapeutic Apheresis and Dialysis
IS - 1
ER -