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Low calcium dialysate and hyperparathyroidism.
Perit Dial Int. 1996; 16 Suppl 1:S499-502.PD

Abstract

A low calcium dialysate reduces hypercalcemia from calcium-containing phosphate binders and makes phosphate control possible without the use of aluminum salts. We asked whether this might, however, lead to hyperparathyroidism. We prospectively studied serum concentrations of parathyroid hormone levels (by an immunoreactive intact molecule assay) in 173 patients on continuous ambulatory peritoneal dialysis (CAPD) who were started on a low calcium dialysate (Ca2+ 1.25 or 1.00 mmol/L) because of hypercalcemia. Median follow-up was 13.2 months (range 1-28). Initial serum parathyroid hormone was [median(range)]: 70(5-1043) ng/L pre low calcium dialysate, and this rose to 130(5-914) ng/L at 0-6 months; 130(5-1030) ng/L at 6-12 months; 170(170-1400) ng/L at 12-18 months; and 130(5-1200) ng/L at 18-24 months (p = 0.0006). Twenty-two patients required a parathyroidectomy because of a sustained rise in parathyroid hormone that was not responsive to alfacalcidol and hypercalcemia. Initial serum parathyroid hormone was significantly higher in these patients at 359 (5-1073) ng/L as compared to a level of 69.5 (6-1147) ng/L in patients who did not have a parathyroidectomy (p = 0.0009). There was a significant sustained fall in mean serum corrected calcium from 2.77 (2.37-3.51) mmol/L to 2.53 (1.39-3.20) mmol/L at three months (p = 0.0006), a nonsignificant rise in mean serum alkaline phosphate from 179 (47-1858) mmol/L to 191 (55-1821) mmol/L (p = 0.15), and a fall in mean serum phosphate levels from 1.87 (0.59-3.18) mmol/L to 1.68 (0.45-3.6) mmol/L (p = 0.76). Our data suggest that the benefits of a low calcium dialysate in CAPD patients are balanced by an increased risk of hyperparathyroidism, and that this risk is higher in patients with an initially high serum parathyroid hormone level.

Authors+Show Affiliations

Queen Elizabeth Hospital, Birmingham, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8728256

Citation

Duncan, R, et al. "Low Calcium Dialysate and Hyperparathyroidism." Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, vol. 16 Suppl 1, 1996, pp. S499-502.
Duncan R, Cochrane T, Bhalla C, et al. Low calcium dialysate and hyperparathyroidism. Perit Dial Int. 1996;16 Suppl 1:S499-502.
Duncan, R., Cochrane, T., Bhalla, C., Michael, J., Richards, N. T., & Adu, D. (1996). Low calcium dialysate and hyperparathyroidism. Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 16 Suppl 1, S499-502.
Duncan R, et al. Low Calcium Dialysate and Hyperparathyroidism. Perit Dial Int. 1996;16 Suppl 1:S499-502. PubMed PMID: 8728256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low calcium dialysate and hyperparathyroidism. AU - Duncan,R, AU - Cochrane,T, AU - Bhalla,C, AU - Michael,J, AU - Richards,N T, AU - Adu,D, PY - 1996/1/1/pubmed PY - 1996/1/1/medline PY - 1996/1/1/entrez SP - S499 EP - 502 JF - Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis JO - Perit Dial Int VL - 16 Suppl 1 N2 - A low calcium dialysate reduces hypercalcemia from calcium-containing phosphate binders and makes phosphate control possible without the use of aluminum salts. We asked whether this might, however, lead to hyperparathyroidism. We prospectively studied serum concentrations of parathyroid hormone levels (by an immunoreactive intact molecule assay) in 173 patients on continuous ambulatory peritoneal dialysis (CAPD) who were started on a low calcium dialysate (Ca2+ 1.25 or 1.00 mmol/L) because of hypercalcemia. Median follow-up was 13.2 months (range 1-28). Initial serum parathyroid hormone was [median(range)]: 70(5-1043) ng/L pre low calcium dialysate, and this rose to 130(5-914) ng/L at 0-6 months; 130(5-1030) ng/L at 6-12 months; 170(170-1400) ng/L at 12-18 months; and 130(5-1200) ng/L at 18-24 months (p = 0.0006). Twenty-two patients required a parathyroidectomy because of a sustained rise in parathyroid hormone that was not responsive to alfacalcidol and hypercalcemia. Initial serum parathyroid hormone was significantly higher in these patients at 359 (5-1073) ng/L as compared to a level of 69.5 (6-1147) ng/L in patients who did not have a parathyroidectomy (p = 0.0009). There was a significant sustained fall in mean serum corrected calcium from 2.77 (2.37-3.51) mmol/L to 2.53 (1.39-3.20) mmol/L at three months (p = 0.0006), a nonsignificant rise in mean serum alkaline phosphate from 179 (47-1858) mmol/L to 191 (55-1821) mmol/L (p = 0.15), and a fall in mean serum phosphate levels from 1.87 (0.59-3.18) mmol/L to 1.68 (0.45-3.6) mmol/L (p = 0.76). Our data suggest that the benefits of a low calcium dialysate in CAPD patients are balanced by an increased risk of hyperparathyroidism, and that this risk is higher in patients with an initially high serum parathyroid hormone level. SN - 0896-8608 UR - https://www.unboundmedicine.com/medline/citation/8728256/Low_calcium_dialysate_and_hyperparathyroidism_ DB - PRIME DP - Unbound Medicine ER -