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Effects of reduced dialysate calcium on calcium-phosphorus product and bone metabolism in hemodialysis patients.
Nephron Clin Pract. 2004; 96(1):c3-9.NC

Abstract

BACKGROUND

The safety of using reduced calcium dialysate (RDC) in hemodialysis (HD) patients is controversial due to related changes in bone metabolism. In the present study we investigated whether an 18-month treatment period with RDC may induce significant changes in calcium-phosphorus product (CaxP), bone metabolism, and components of the insulin-like growth factor (IGF) system in HD patients.

STUDY DESIGN

In this prospective study, 13 HD patients with biochemical signs of diminished or low-normal bone turnover and high CaxP due to high serum calcium level were treated by lowering dialysate calcium from 3.5 to 2.5 mEq/l for 18 months. By specific immunometric assays, serum levels of intact parathyroid hormone (PTH), bone alkaline phosphatase (B-ALP), pyridinoline (PYR), desoxypyridinoline (D-PYR), 25-OH-vitamin D(3) (25-vit D(3)), 1,25-(OH)(2)-vitamin D(3) (1,25-vit D(3)), free IGF-I, IGF-II, and IGF-binding protein (IGFBP)-1 to -6 were measured.

RESULTS

CaxP decreased significantly from 5.62 (baseline) to 3.95 mmol(2)/l(2) (at 18 months), whereas PTH increased from 81 +/- 57 pg/ml at baseline to 236 +/- 188 at 12 months (p < 0.01), remaining in this range thereafter. Parameters of bone resorption (PYR) as well as formation (B-ALP) significantly increased during RDC, with peak levels after 12 months. Despite increasing doses of oral alfacalcidol, levels of 25-vit D(3) and 1,25-vit D(3) subsequently declined during RDC. In parallel with the changes in bone markers, free IGF-I levels decreased (baseline: 1.9 +/- 0.9 ng/ml, after 18 months: 1.1 +/- 0.7; p < 0.01). The decline of free IGF-I correlated with decreasing levels of IGFBP-3 and increasing levels of IGFBP-1/-4.

CONCLUSION

The treatment with RDC effectively lowered CaxP and stimulated bone formation and resorption. The different changes in bone markers and IGF system components mirror the complex effects on bone metabolism.

Authors+Show Affiliations

Department of Nephrology, Martin Luther University Halle-Wittenberg, Halle, Germany. roman.fiedler@medizin.uni-halle.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14752247

Citation

Fiedler, Roman, et al. "Effects of Reduced Dialysate Calcium On Calcium-phosphorus Product and Bone Metabolism in Hemodialysis Patients." Nephron. Clinical Practice, vol. 96, no. 1, 2004, pp. c3-9.
Fiedler R, Deuber HJ, Langer T, et al. Effects of reduced dialysate calcium on calcium-phosphorus product and bone metabolism in hemodialysis patients. Nephron Clin Pract. 2004;96(1):c3-9.
Fiedler, R., Deuber, H. J., Langer, T., Osten, B., Mohan, S., & Jehle, P. M. (2004). Effects of reduced dialysate calcium on calcium-phosphorus product and bone metabolism in hemodialysis patients. Nephron. Clinical Practice, 96(1), c3-9.
Fiedler R, et al. Effects of Reduced Dialysate Calcium On Calcium-phosphorus Product and Bone Metabolism in Hemodialysis Patients. Nephron Clin Pract. 2004;96(1):c3-9. PubMed PMID: 14752247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of reduced dialysate calcium on calcium-phosphorus product and bone metabolism in hemodialysis patients. AU - Fiedler,Roman, AU - Deuber,Heinz J, AU - Langer,Thomas, AU - Osten,Bernd, AU - Mohan,Subburaman, AU - Jehle,Peter M, PY - 2003/08/18/received PY - 2003/08/24/accepted PY - 2004/1/31/pubmed PY - 2004/5/5/medline PY - 2004/1/31/entrez SP - c3 EP - 9 JF - Nephron. Clinical practice JO - Nephron Clin Pract VL - 96 IS - 1 N2 - BACKGROUND: The safety of using reduced calcium dialysate (RDC) in hemodialysis (HD) patients is controversial due to related changes in bone metabolism. In the present study we investigated whether an 18-month treatment period with RDC may induce significant changes in calcium-phosphorus product (CaxP), bone metabolism, and components of the insulin-like growth factor (IGF) system in HD patients. STUDY DESIGN: In this prospective study, 13 HD patients with biochemical signs of diminished or low-normal bone turnover and high CaxP due to high serum calcium level were treated by lowering dialysate calcium from 3.5 to 2.5 mEq/l for 18 months. By specific immunometric assays, serum levels of intact parathyroid hormone (PTH), bone alkaline phosphatase (B-ALP), pyridinoline (PYR), desoxypyridinoline (D-PYR), 25-OH-vitamin D(3) (25-vit D(3)), 1,25-(OH)(2)-vitamin D(3) (1,25-vit D(3)), free IGF-I, IGF-II, and IGF-binding protein (IGFBP)-1 to -6 were measured. RESULTS: CaxP decreased significantly from 5.62 (baseline) to 3.95 mmol(2)/l(2) (at 18 months), whereas PTH increased from 81 +/- 57 pg/ml at baseline to 236 +/- 188 at 12 months (p < 0.01), remaining in this range thereafter. Parameters of bone resorption (PYR) as well as formation (B-ALP) significantly increased during RDC, with peak levels after 12 months. Despite increasing doses of oral alfacalcidol, levels of 25-vit D(3) and 1,25-vit D(3) subsequently declined during RDC. In parallel with the changes in bone markers, free IGF-I levels decreased (baseline: 1.9 +/- 0.9 ng/ml, after 18 months: 1.1 +/- 0.7; p < 0.01). The decline of free IGF-I correlated with decreasing levels of IGFBP-3 and increasing levels of IGFBP-1/-4. CONCLUSION: The treatment with RDC effectively lowered CaxP and stimulated bone formation and resorption. The different changes in bone markers and IGF system components mirror the complex effects on bone metabolism. SN - 1660-2110 UR - https://www.unboundmedicine.com/medline/citation/14752247/Effects_of_reduced_dialysate_calcium_on_calcium_phosphorus_product_and_bone_metabolism_in_hemodialysis_patients_ L2 - https://www.karger.com?DOI=10.1159/000075565 DB - PRIME DP - Unbound Medicine ER -