| Theme | The concepts of the new JSDT clinical guideline on CKD-MBD | |
|---|---|---|
| Title | Dialysate calcium concentrations | |
| Publish Date | 2013/01 | |
| Author | Daisuke Koreeda | Division of Nephrology, Wakayama Medical University |
| Author | Takashi Shigematsu | Division of Nephrology, Wakayama Medical University |
| [ Summary ] | Dialysate calcium concentrations (Dca) can interfere with the calcium balance of end-stage kidney disease patients undergoing renal replacement therapy. In Japan, physicians must choose a primary Dca treatment system from four possibilities (Dca : 2.5, 2.75, 3.0, or 3.0 mEq/L with high bicarbonate) for HD patients. A near neutral dialysate in terms of Ca balance may be a Dca 2.75 mEq/L HD compound. For CAPD patients, we also have four Dca choices (2.0, 2.5, 3.5, or 4.0 mEq/L). A neutral Dca may be achieved with a 3.25 mEq/L CAPD dialysate level. Therefore, we cannot use nearly neutral Dca dialysates for CAPD patients. However, we have many effective compounds for CKD-MBD treatment, such as VDRA, calcimimetics, Ca compounds and other non-calcium phosphate binders. We can coordinate serum Ca / phosphate and PTH levels through use of combination therapy by prescribing multiple CKD-MBD drugs with any Dca dialysate. In the future, new therapeutic strategies must be developed through research on combination therapy involving renal replacement therapy with individual Dca dialysates. |
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