Effects of Dialysate Calcium Concentration and Calcitriol on Bone Metabolism in Hemodialysis Patients.
- Author:
Ji Youn YOUM
1
;
Hyun Chul KIM
;
Young Chul LEE
;
Jong Wook CHOI
;
Joon Sung PARK
;
Chang Hwa LEE
;
Chong Myung KANG
;
Gheun Ho KIM
Author Information
1. Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. kimgh@hanyang.ac.kr
- Publication Type:Original Article
- Keywords:
Hemodialysis solution;
Calcium;
Parathyroid hormone;
Calcitriol;
Renal osteodystrophy
- MeSH:
Alkaline Phosphatase;
Bone Diseases;
Calcitriol;
Calcium;
Humans;
Hypercalcemia;
Parathyroid Hormone;
Phosphorus;
Renal Dialysis;
Renal Osteodystrophy
- From:Korean Journal of Medicine
2011;81(6):751-758
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: Whereas higher dialysate calcium (Ca) levels may pose a risk of hypercalcemia, lower levels may induce a negative Ca balance. We evaluated the effect of lowering dialysate Ca levels from 1.75 to 1.5 mmol/L and explored the appropriate use of calcitriol to regulate bone metabolism in hemodialysis patients. METHODS: The dialysate Ca levels of 36 patients were reduced from 1.75 to 1.5 mmol/L. They were divided into three groups according to basal intact parathyroid hormone (iPTH) level (group 1, iPTH < 150 pg/mL, n = 21; group 2, iPTH 150-300 pg/mL, n = 7; group 3, iPTH > 300 pg/mL, n = 8). Data were collected at 3-month intervals for 1 year. RESULTS: Throughout the study period, no significant difference in phosphate binders, serum Ca, phosphorus (P), or Ca x P products was observed among groups. However, iPTH, alkaline phosphatase (AP), and calcitriol dosage patterns differed among groups. In group 1, iPTH and AP increased significantly over 12 months (p = 0.01). In group 2, iPTH and AP showed no significant changes. In group 3, iPTH and AP declined significantly over 12 months (p = 0.02). Calcitriol dosage did not change in groups 1 and 2, but increased significantly in group 3 (p = 0.001). CONCLUSIONS: After converting hemodialysate Ca levels from 1.75 to 1.5 mmol/L, the initially different iPTH concentrations converged to a modestly elevated level. The use of 1.5 mmol/L hemodialysate Ca may thus be appropriate for both high- and low-turnover bone disease if phosphate binders and calcitriol are combined appropriately.
