| [ Summary ] |
Optimal dialysate calcium concentrations have been discussed in long term duration. However, conclusions about the ideal dialysate calcium concentration have not yet been reached. Through the clinical use of active vitamin D3 metabolites many chronic hemodialysis patients' levels changed from negative to positive calcium balances. These positive calcium balances were accelerated by a change in phosphate binder from aluminium to calcium compounds. Under such circumstances, in many dialysis centers, dialysate calcium concentrations changed from a high of (Ca 3.5 to 4.0mEq/l) to a low of (Ca 2.5mEq/l). However, in several dialysis centers the change of dialysate calcium concentration was not performed, so hypercalcemia and ectopic calcification were frequently observed. Now we can use new vitamin D3 metabolites intravenously, so the risk of hypercalcemia has increased and we may have to consider the use of even lower levels of calcium dialysate. However, it will soon be possible to use new calcium free phosphate binders and calcimimetics, having the potential to create negative calcium balances, so we will again have to investigate concerns related to calcium balance and dialysate calcium concentrations. |