HDCN Article Review/Hyperlink

Bro S, Brandi L, Olgaard K

High-normal calcium (1.35 mmol/l) dialysate in patients on CAPD: eficient and safe long-term control of plasma calcium, phosphate, and parathyroid hormone

Nephrol Dial Transplant (Aug) 11:1586-1591 1996

The aim of the study was to examine the long-term efficacy and safety of treatment with a high normal calcium dialysate, 1.35 mmol/l (2.7 meq/l, 5.4 mg/dl) in patients on CAPD. Thirty-seven non-selected patients were switched from a dialysate Ca of 1.75 (3.5 meq/l, 7 mg/dl) to the lower concentration of dialysate Ca. The mean follow-up was 10 months (range 3-12 months). After an initial decline in Ica and increase in PTH, the dose of CaCO3 and alfacalcidol could be increased in many with good control of Ica, Phosphorus, and PTH. In those with relatively low levels of PTH, discontinuation of vitamin D allowed an increase in PTH levels to approximately twice normal. Hypercalcemia was infrequent. The authors conclude that this dialysate concentration is a first-choice therapy for the majority of patients starting CAPD treatment.

Comment: According to my count, this is the thirteenth study evaluating the effects of a dialysate Ca of less than 3.5 meq/l on mineral metabolism in CAPD patients. The results have been quite conflicting. In large part, this is probably due to variable control of Ca and P levels possibly due to compliance and/or clinical monitoring differences. The results of this study are probably overstated (the changes are not all that dramatic) but they are consistent with common logic. Most patients benefit from a dialysate Ca less than 3.5 meq/l using Ca salts as the primary phosphorus binder. Patients with poor compliance in taking binders and in restricting dietary phosphorus should probably not be on a lower Ca dialysate. Careful follow-up and frequent adjustments of medications are usually necessary to optimize mineral metabolism in CAPD patients treated with the lower Ca dialysate. (Jay Delmez, M.D., Washington University at St. Louis, MO)

The full text of this abstract is available from Oxford Press at this site.