Blood calcium balance and dialysate calcium concentration in heamodialysis patients in Thi- Qar Province, Iraq

  • Zainab Ali Kadhem MSc. Biochemistry (Lecturer), Department of Medical Chemistry, College of Medicine, Thi- Qar University, Iraq
Keywords: Blood calcium balance, heamodialysis, dialysate calcium concentration

Abstract

Objective: This study designed to assess whether dialysate calcium concentration is adequate to maintain blood calcium balance in patients receiving hemodialysis therapy or not adequate. Patients and Methods:  We evaluated 170 patients undergoing chronic kidney disease in dialysis unit at AL- Hussein teaching hospital in Thi - Qar province. Results:  The 170 patient included  70 (30%) were female and   100 (70 %)  were  male, aged from 19 to  90  years,  the duration of dialysis session  3hour per day,  number of dialysis session per week  was two time per week for all heamodialysis patients, and  dialysate calcium concentration was 1.75 mmol/L. Results show normal calcemia in pre and post dialysis session in 30 patients  (17.65%) their serum calcium  was within normal range 2.24 - 2.5 mmol/L with no significant change (p > 0.05), and  48  (28.24%)  show changes in serum calcium  from 1.75 ±  0.11in pre to 2.32 ±  0.24 mmol/L  in post HD session  with no significant changes (p > 0.05),  but  92 ( 54.24%) patients were diagnosed with hypocalcemia in pre  1.48 ± 0.16 and post 1.72 ±  0.20 dialysis session also with no significant change (p > 0.05). Conclusions: the concentration of dialysate calcium 1.75 mmol/l (3.5 mEq/L) was adequate and   frequently used with the aim of obtaining positive blood calcium balance especially in patients with normal ( [Ca ] < 2.40 mmol/L) or Pre  hypocalcaemia ( [Ca]  ≥ 1.75  mmol/L). But in  patients with  severe degree  pre - hypocalcemia ( [Ca ] ≤ 1.48 mmol/l) dialysate Ca concentration (1.75 mmol/L) should be increased by ~ 0.25 mmol/L to maintain comparable balances as possible as  or treated  with calcium gluconate (10 % w/v) injection ampoule 10 ml  (1ml ≈ 0.23 mmol/L) after HD session.

References

Pendse S, Singh A, Zawada E. Initiation of Dialysis. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:14–21.

Llach F, Yudd M. Pathogenic, clinical and therapeutic aspects of secondary hyperparathyroidism in chronic renal failure. Am J Kidney Dis. 1998; 32:S3–S12.

McIntyre CW: Calcium balance during hemodialysis. Semin Dial 21: 38–42, 2008.

Nigel toussain T, Patrick cooney, Peter G. kerr : Review of dialysate calcium concentration in hemodialysis . Hemodialysis International 2006; 10:326–337.

National Kidney Foundation. (K/DOQI ) clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42(Suppl 3):S1–S202.

Stu E. NA¨ PPI , vesa k. virtanen, heikki h.T. saha, jukka T. mustonen, and amos I. pasternack : QTc dispersion increases during hemodialysis with low-calcium dialysate. Kidney International, Vol. 57 (2000), pp. 2117–2122.

Malberti F, Surian M, Poggio F, Minoia C, Salvadeo A. Efficacy and safety of long-term treatment with calcium carbonate as a phosphate binder. Am J Kidney Dis. 1988; 6:487–491.

Binswanger U. Calcium flux during hemodialysis. Semin Dial. 1990; 1:1–2.

Argiles A, Mourad G. How do we have to use the calcium in the dialysate to optimize the management of secondary hyperparathyroidism. Nephrol Dial Transplant. 1998; 13(Suppl 3):62–64.

Satu E. Nappi, Heikki H.T. Saha, Vesa K. Virtanen, Jukka T. Mustonen, and amos I.Pasternack: Hemodialsis with high-calcium dialsate impairs cardiac relaxation., kidney international, Vol. 55 (1999), pp. 1091-1096.

Iavtop. S.Sunder, O. P. Kalra, V. waghmare, R Ruchi, A .Raizda : Extensive calcific uremic arteriolopathy in a patient on automated peritoneal dialysis.Indian journal of nephrology .(2007) vol (17) : issue 2.

Zoanne Burgess Schnell, , RN Anne M.Van Leeuwen, Todd R. Kranpitz :Davis’s Comprehensive Laboratory and Diagnostic Test Handbook—with Nursing Implications, Davis company , Philadelphia. 2003 by F. A. Davis Company P 289. F.

Kopple JD, Coburn JW. Metabolic studies of low protein diets in uremia. II. Calcium, phosphorus and magnesium. Medicine 1973; 52: 597-607.

Hou SH, Zhao J & Ellman CF et al. Calcium and phosphorus fluxes during hemodialysis with low calcium dialysate. Am J Kidney Dis 1981; 18: 217–224.

Ermakova I, Novikov A, Pronchenko I. Use of the equipment for hemodialysis in the diagnosis of calcium metabolism disorders in terminal chronic renal failure. Med Tekh. 1991; 1:27–29.

Ulozas E, Chebrolu S, Shanaah A, Daoud T, Leehey D, Ing T. Symptomatic hypocalcemia due to the inadvertent use of a calcium-free hemodialysate. Artif Organs. 2004;28:229–231.

Foley RN, Parfrey PS, Harnett JD, Kent GM, Hu L, O'Dea R, Murray DC, Barre PE. Hypocalcemia, morbidity, and mortality in end-stage renal disease. Am J Nephrol. 1996;16(5):386-93.

Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990; 15: 458–82.

Foley RN, Parfrey PS, Harnett JD et al. The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. Am J Kidney Dis 1996; 28: 53–61.

Block GA, Klassen PS, Lazarus JM et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004; 15: 2208–18.

Young EW, Albert JM, Satayathum S et al. Predictors and consequences of altered mineral metabolism. The Dialysis Outcomes Practice Patterns Study. Kidney Int 2005; 67: 1179–87.

Zhang DL1, Wang LY, Sun F, Zhou YL, Duan XF, Liu S, Sun Y, Cui TG, Liu WH Is the Dialysate Calcium Concentration of 1.75 mmol/L Suitable for Chinese Patients on Maintenance Hemodialysis? (2013) 94(3):301-10.

Maduell F, Gorriz JL, Pallardo LM, et al. Assessment of phosphorus and calcium metabolism and its clinical management in hemodialysis patients in the community of Valencia. J Nephrol. 2005;186:739-48.

Published
2021-03-10
Section
Articles