Calcium Concentration in the Capd Dialysate: What is Optimal and is There a Need to Individualize?

1997 ◽  
Vol 17 (6) ◽  
pp. 554-559 ◽  
Author(s):  
Susanne Bro ◽  
Lisbet Brandi ◽  
Henrik Daugaard ◽  
Klaus Olgaard
Keyword(s):  
Vitamin D ◽  
Calcium Carbonate ◽  
Calcium Concentration ◽  
Phosphate Binders ◽  
Vitamin D Metabolites ◽  
Plasma Phosphate ◽  
Study Selection ◽  
Initial Decrease ◽  
Stable Plasma ◽  
Dialysate Calcium

Objective To evaluate risk/benefit of various continuous ambulatory peritoneal dialysis (CAPD) dialysate calcium concentrations. Data Sources A review of the literature on the effects of various CAPD dialysate Ca concentrations on plasma Ca, plasma phosphate, plasma parathyroid hormone (PTH), doses of calcium carbonate, doses of vitamin D analogs, and requirements of aluminum-containing phosphate binders. Study Selection Eleven studies of nonselected CAPD patients, and 13 studies of CAPD patients with hypercalcemia were reviewed. Results In nonselected CAPD patients, treatment with a reduced dialysate Ca concentration (1.00, 1.25, or 1.35 mmol/L) improved the tolerance to calcium carbonate and/or vitamin D metabolites and reduced the need for Al-containing phosphate binders. When using dialysate Ca 1.25 or 1.35 mmol/L, the initial decrease of plasma Ca and increase of PTH could easily be reversed with an immediate adjustment of the treatment. After 3 months, stable plasma Ca and PTH levels could be maintained using only monthly investigations. In patients with hypercalcemia and elevated PTH levels, treatment with dialysate Ca concentrations below 1.25 mmol/L implied a considerable risk for the progression of secondary hyperparathyroidism. When hypercalcemia was present in combination with suppressed PTH levels, a controlled increase of PTH could be obtained with a temporary discontinuation of vitamin D and/or a reduction of calcium carbonate treatment in combination with a dialysate Ca concentration of 1.25 or 1.35 mmol/L. Conclusion Most CAPD patients can be treated effectively and safely with a reduced dialysate Ca concentration of 1.35 or 1.25 mmol/L. Treatment with dialysate Ca concentrations below 1.25 mmol/L should not be used. A small fraction of patients with persistent hypocalcemia need treatment with high dialysate Ca, such as 1.75 mmol/L.

Transperitoneal Calcium Mass Transfer using Dialv Sate with a Low Calcium Concentration (1.0 mM)

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 467-470 ◽  
Author(s):  
Thomas Weinreich ◽  
A. Colombi ◽  
H.H. Echterhoff ◽  
G. Mielke ◽  
M. Nebel ◽  
...  
Keyword(s):  
Mass Transfer ◽  
Calcium Concentration ◽  
Phosphate Binders ◽  
Total Serum ◽  
Vitamin D Metabolites ◽  
Low Calcium ◽  
Total Serum Calcium ◽  
Before And After ◽  
To Receive ◽  
Dialysate Calcium

Lower dialysate calcium concentrations were recently proposed to overcome the risk of hypercalcemia In continuous ambulatory peritoneal dialysis (CAPD) patients on calcium containing phosphate binders and/or vitamin D metabolites using the standard dialysate calcium concentration (sCa) of 1.75 mM. To assess transperitoneal calcium mass transfer (CaMT) in CAPD patients using a dialysate with a low calcium concentration (LCa, 1.00 mM), 18 stable patients were randomly allocated to receive either LCa or SCa. CaMT was assessed over 4 hours using 2L dialysate bags with three different dialysate glucose concentrations (1.5%, 2.3%, 4.25%). Total serum calcium (tCa), Ionized calcium (iCa), and the exact dialysate volume were measured before and after the 4-hour dwell. A sample of the drained dialysate was obtained to measure the dialysate calcium concentration. The tCa and iCa levels were not significantly different In both groups prior to and did not change throughout the test. CaMT (median/range) was .0.64 mmol/exchange (0.35 –1.29 mmol/exchange) using LCa with 1.5% glucose compared to 0.23 mmol (.0.18 -0.87 mmol) with SCa (p<0.0001). CaMT was negatively correlated to ICa and ultrafiltration volume [4.25%: LCa -1.22 (.0.84 -1.9); SCa .0.43 (-1.35 -0.13); p<0.001]. In summary, LCa results in a loss of calcium into the dialysate even at low ultrafiltration volumes and serum ICa levels. This might facilitate the prevention and therapy of renal osteodystrophy with calclum-containing phosphate binders and calcitriol. However, patients using LCa must be carefully monitored for calcium homeostasis and bone turnover.

scholarly journals Dynamic changes in calcium and phosphate plasma concentrations in the patients on peritoneal dialysis

2006 ◽  
Vol 63 (1) ◽  
pp. 27-30
Author(s):  
Natasa Jovanovic ◽  
Mirjana Lausevic ◽  
Biljana Stojimirovic
Keyword(s):  
Vitamin D ◽  
Renal Failure ◽  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Calcium Concentration ◽  
Phosphate Binders ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Stage Renal Disease ◽  
End Stage

Background/Aim. The disturbances of active forms of vitamin D synthesis and disturbances in calcium and posphate metabolism develop early in chronic renal failure, when creatinine clearance is about 30 ml/min. Chronic hemodialysis and peritoneal dialysis only partially correct the biochemical environment of patients on chronic renal replacement therapy because of end-stage renal disease. These dialysis modalities can?t significantly affect the endocrine disturbances of chronic renal failure and they have minimal modulatory effect. The management of disturbed calcium (Ca) and phosphate (P) metabolism and the maintainance of Ca ? P product below 4.4 mmol/l thanks to the use of dialysate solutions with the appropriate calcium concentration and the careful dosage of phosphate binders, calcium and active vitamin D metabolits, are extremely important for the prevention of renal osteodystrophy, secondary hyperparathyroidism as well as low-bone turnover disease. The aim of the study was to analyze the plasma levels of calcium, phosphate, albumin, alkaline phosphatase and parathormon (PTH) in 58 patients who were treated with continuous ambulatory peritoneal dialysis (CAPD) from March to August 2003. The use of phosphate binders and the substitution with active vitamin D metabolits were also analyzed. Methods. We examined 58 patients, 30 males and 28 female, mean-age 52 years (range, 26-78 years), affected by end-stage renal disease of the different leading cause. The average time on peritoneal dialysis program was 20 months (2-66 months). Most of the patients were treated by CAPD, while only few of them performed automatic, cyclic or intermittent peritoneal dialysis. Most of the patients used a dialysate with 1.75 mmol/l calcium concentration. Results. The study showed that our patients on chronic CAPD program during several months had normal calcemia, phosphatemia and the level of alkaline phosphatase, and that they had Ca ? P product in the recommended range. PTH serum level ranged from 16 to 490 pg/l in our patients. Conclusion. The study showed that a balanced diet and a correct dosage of phosphate binders, as well as a careful substitution with active vitamin D metabolits render a good control of calcium and phosphate serum balance, as well as an effective prevention of renal osteodystrophy development in the patients on chronic peritoneal dialysis treatment.

Renal Osteodystrophy in Peritoneal Dialysis: Special Considerations

2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 11-19 ◽  
Author(s):  
Ronen Levy ◽  
Anca Gal-Moscovici
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Bone Lesion ◽  
Phosphate Binders ◽  
Vitamin D Metabolites ◽  
Bone Disorder

Bone disease is one of the most challenging complications in patients with chronic kidney disease. Today, it is considered to be part of a complex systemic disorder manifested by disturbances of mineral metabolism and vascular calcifications called chronic kidney disease – mineral bone disorder (CKD-MBD). The term renal osteodystrophy is reserved to define the specific bone lesion in CKD-MBD, whose spectrum ranges from high turnover to low turnover disease. Phosphate retention, decreased serum calcium, and 1,25-dihydroxy vitamin D synthesis are involved in the pathogenesis of high bone turnover. However, the various therapeutic approaches (calcium supplements, phosphate binders, and vitamin D metabolites, among others), the renal replacement modality (hemodialysis or continuous ambulatory peritoneal dialysis), and the types of patients to whom dialysis is offered (more patients who are diabetic or older, or both) may influence the evolution of the bone disorder. As a result, recent studies have reported a greater prevalence of adynamic forms of renal osteodystrophy, especially in diabetic and peritoneal dialysis patients. The present article reviews, for patients treated with peritoneal dialysis, the pathophysiologic mechanisms involved in the evolution and perpetuation of this bone disease and the therapeutic modalities for treating and preventing adynamic bone.

The Influence of Dialysate Calcium Concentration on the Pth Level in Children Undergoing Capd

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 567-569 ◽  
Author(s):  
Maria Sieniawska ◽  
Maria Roszkowska-Blaim ◽  
Beata Wojciechowska
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Dwell Time ◽  
Calcium Concentration ◽  
Vitamin D Metabolites ◽  
Intact Parathyroid Hormone ◽  
Gland Function ◽  
Dialysate Calcium ◽  
Pth Level

In 12 children aged four-and-a-half to 18 years (mean 11 ±4.2) undergoing continuous ambulatory peritoneal dialysis (CAPO), serum intact parathyroid hormone (iPTH), ionized calcium (iCa) levels, and calcium mass transfer (CaMT) were measured on three consecutive days: day 1, after a four-hour interval between dialyses; on day 2, after four hours dwell time with peritoneal dialysis (PD) Ca 3.5 mEq/L; and on day 3, after four hours dwell time with PD Ca 2.5 mEq/L. A significantly more negative CaMT was found when PD Ca 2.5 mEq/L was used, as compared with values obtained using PD Ca 3.5 mEq/L. Significantly lower parathyroid hormone (PTH) values were found after the interval between exchanges. We conclude that in order to properly evaluate parathyroid gland function and to decide whether or not to give vitamin D metabolites, a protocol for determining PTH should be standardized.

scholarly journals Calcium Carbonate versus Sevelamer Hydrochloride as Phosphate Binders after Long-Term Disease Progression in 5/6 Nephrectomized Rats

2014 ◽  
Vol 2014 ◽  
pp. 1-10
Author(s):  
Suvi Törmänen ◽  
Arttu Eräranta ◽  
Asko Riutta ◽  
Peeter Kööbi ◽  
Teemu Honkanen ◽  
...  
Keyword(s):  
Renal Function ◽  
Calcium Carbonate ◽  
Creatinine Clearance ◽  
Disease Progression ◽  
Urinary Calcium ◽  
Phosphate Binders ◽  
Plasma Phosphate ◽  
Blood Ph ◽  
Fgf 23

Our aim was to compare the effects of calcium carbonate and sevelamer-HCl treatments on calcium-phosphate metabolism and renal function in 5/6 nephrectomized (NX) rats so that long-term disease progression preceded the treatment. After 15-week progression, calcium carbonate (3.0%), sevelamer-HCl (3.0%), or control diets (0.3% calcium) were given for 9 weeks. Subtotal nephrectomy reduced creatinine clearance (−40%), plasma calcidiol (−25%), and calcitriol (−70%) and increased phosphate (+37%), parathyroid hormone (PTH) (11-fold), and fibroblast growth factor-23 (FGF-23) (4-fold). In NX rats, calcium carbonate diet increased plasma (+20%) and urinary calcium (6-fold), reduced plasma phosphate (−50%) and calcidiol (−30%), decreased creatinine clearance (−35%) and FGF 23 (−85%), and suppressed PTH without influencing blood pH. In NX rats, sevelamer-HCl increased urinary calcium (4-fold) and decreased creatinine clearance (−45%), PTH (−75%), blood pH (by 0.20 units), plasma calcidiol (−40%), and calcitriol (−65%). Plasma phosphate and FGF-23 were unchanged. In conclusion, when initiated after long-term progression of experimental renal insufficiency, calcium carbonate diet reduced plasma phosphate and FGF-23 while sevelamer-HCl did not. The former induced hypercalcemia, the latter induced acidosis, while both treatments reduced vitamin D metabolites and deteriorated renal function. Thus, delayed initiation influences the effects of these phosphate binders in remnant kidney rats.

Vitamin D Metabolism in Patients Intoxicated with Ergocalciferol

1985 ◽  
Vol 68 (2) ◽  
pp. 135-141 ◽  
Author(s):  
E. Barbara Mawer ◽  
J. T. Hann ◽  
Jacqueline L. Berry ◽  
M. Davies
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Mass Action ◽  
Vitamin D Metabolites ◽  
Serum Concentrations ◽  
High Concentration ◽  
Vitamin D Metabolism ◽  
Serum Calcium Concentration ◽  
Per Se

1. Vitamin D metabolites were measured on admission in eight patients intoxicated with ergocalciferol (serum calcium 3.01-4.05 mmol/l) and also during the subsequent 2 months in six of the eight. 2. Serum concentrations of 25-hydroxyergocalciferol, on admission, were grossly elevated in all patients (range 583-1843 nmol/l). 3. Serum calcium concentration was related significantly only to the concentration of 25-hydroxyergocalciferol (P = 0.003). 4. Concentrations of 25-hydroxyergocalciferol in serum were significantly related to those of calciferol (P = 0.004). 5. Elevated initial concentrations of 1,25-dihydroxycalciferol, mainly as 1,25-dihydroxyergocalciferol, were found in seven of the eight patients (range 179-313 pmol/l). 6. It is suggested that the hypercalcaemia in these patients may be explained by the action of 25-hydroxyergocalciferol at high concentration in competing for 1,25-dihydroxycalciferol receptors, thus exerting a biological effect per se, and also by increasing the synthesis of 1,25-dihydroxycalciferol through a mass-action effect on the renal 1α-hydroxylase.

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