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Low-calcium dialysate stimulates parathormone secretion and its long-term use worsens secondary hyperparathyroidism.
J Am Soc Nephrol. 1995 Jul; 6(1):132-5.JA

Abstract

The long-term clinical effects of the use of a low calcium concentration in the dialysate are largely unknown. For this reason, the influence of low-calcium dialysate on parathyroid hormone (PTH) secretion in hemodialysis patients and its long-term effect on the severity of secondary hyperparathyroidism were studied. In 35 hemodialysis patients, the dialysate calcium concentration was lowered from 1.75 to 1.25 mmol/L. Twelve months later, serum iPTH levels increased significantly from 18.6 to 33.2 pmol/L and so did alkaline phosphatase levels, from 210 to 330 IU/L, without significant changes in serum calcium or phosphorus levels. Hemodialysis with low-calcium dialysate (1.25 mmol/L) induced a net calcium loss in 10 patients, without modifications in ionized serum calcium levels. In addition, mean serum iPTH increased 20% over baseline levels, reaching the maximal level at 30 min after the start of hemodialysis with low-calcium dialysate. In contrast, mean serum iPTH levels drop dramatically at 30 min of hemodialysis with high-calcium dialysate (1.75 mmol/L). It was concluded that low-calcium dialysate worsens secondary hyperparathyroidism in hemodialysis patients, probably by inducing a negative calcium balance and causing repetitive stimulation of PTH secretion in each dialysis. The maintenance of normal serum calcium levels could be due to PTH-induced calcium mobilization from bone.

Authors+Show Affiliations

Nephrology Service, University Hospital Arnau de Vilanova, Lleida, Spain.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7579066

Citation

Fernández, E, et al. "Low-calcium Dialysate Stimulates Parathormone Secretion and Its Long-term Use Worsens Secondary Hyperparathyroidism." Journal of the American Society of Nephrology : JASN, vol. 6, no. 1, 1995, pp. 132-5.
Fernández E, Borràs M, Pais B, et al. Low-calcium dialysate stimulates parathormone secretion and its long-term use worsens secondary hyperparathyroidism. J Am Soc Nephrol. 1995;6(1):132-5.
Fernández, E., Borràs, M., Pais, B., & Montoliu, J. (1995). Low-calcium dialysate stimulates parathormone secretion and its long-term use worsens secondary hyperparathyroidism. Journal of the American Society of Nephrology : JASN, 6(1), 132-5.
Fernández E, et al. Low-calcium Dialysate Stimulates Parathormone Secretion and Its Long-term Use Worsens Secondary Hyperparathyroidism. J Am Soc Nephrol. 1995;6(1):132-5. PubMed PMID: 7579066.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low-calcium dialysate stimulates parathormone secretion and its long-term use worsens secondary hyperparathyroidism. AU - Fernández,E, AU - Borràs,M, AU - Pais,B, AU - Montoliu,J, PY - 1995/7/1/pubmed PY - 1995/7/1/medline PY - 1995/7/1/entrez SP - 132 EP - 5 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 6 IS - 1 N2 - The long-term clinical effects of the use of a low calcium concentration in the dialysate are largely unknown. For this reason, the influence of low-calcium dialysate on parathyroid hormone (PTH) secretion in hemodialysis patients and its long-term effect on the severity of secondary hyperparathyroidism were studied. In 35 hemodialysis patients, the dialysate calcium concentration was lowered from 1.75 to 1.25 mmol/L. Twelve months later, serum iPTH levels increased significantly from 18.6 to 33.2 pmol/L and so did alkaline phosphatase levels, from 210 to 330 IU/L, without significant changes in serum calcium or phosphorus levels. Hemodialysis with low-calcium dialysate (1.25 mmol/L) induced a net calcium loss in 10 patients, without modifications in ionized serum calcium levels. In addition, mean serum iPTH increased 20% over baseline levels, reaching the maximal level at 30 min after the start of hemodialysis with low-calcium dialysate. In contrast, mean serum iPTH levels drop dramatically at 30 min of hemodialysis with high-calcium dialysate (1.75 mmol/L). It was concluded that low-calcium dialysate worsens secondary hyperparathyroidism in hemodialysis patients, probably by inducing a negative calcium balance and causing repetitive stimulation of PTH secretion in each dialysis. The maintenance of normal serum calcium levels could be due to PTH-induced calcium mobilization from bone. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/7579066/Low_calcium_dialysate_stimulates_parathormone_secretion_and_its_long_term_use_worsens_secondary_hyperparathyroidism_ L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=7579066 DB - PRIME DP - Unbound Medicine ER -