| Theme |
Electrolyte and acid-base disorders in dialysis patients |
| Title |
How to select a dialysate calcium concentration |
| Author |
Naoto Hamano |
Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine |
| Author |
Hirotaka Komaba |
Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine |
| [ Summary ] |
Extracellular calcium concentration is strictly regulated by a coordinated system involving the gut, bone, kidney, and parathyroid glands. Patients with end-stage renal disease are susceptible to calcium imbalance due to loss of urinary calcium excretion and decreased active vitamin D production. During hemodialysis sessions, there is an influx of calcium through passive diffusion and efflux through ultrafiltration. Recently, accumulating data suggest that the use of high calcium dialysate could cause calcium overload and lead to progression of vascular calcification. However, it has also been reported that the use of low calcium dialysate could lead to elevated parathyroid hormone levels and increased bone turnover. Whether the choice of dialysate calcium concentration affects cardiovascular morbidity and mortality is unknown and warrants further research. |