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Article Review/Hyperlink
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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.
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