Effects of dialysate calcium concentration on calcium-phosphorus metabolism in hemodialysis patients

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  • Shinkai Nobuo
    Department of Urology, Sunagawa City Medical Center
  • Yanase Masahiro
    Department of Urology, Sunagawa City Medical Center
  • Kyoda Yuki
    Department of Urology, Sapporo Medical University, School of Medicine
  • Takeuchi Motoi
    Department of Urology, Sapporo Medical University, School of Medicine
  • Takei Fumiyasu
    Department of Urology, Sapporo Medical University, School of Medicine
  • Mizuno Takahiro
    Department of Urology, Sapporo Medical University, School of Medicine
  • Nakajima Takaharu
    Department of Clinical Engineering, Sunagawa City Medical Center
  • Miura Ryoichi
    Department of Clinical Engineering, Sunagawa City Medical Center
  • Chubachi Jun
    Department of Clinical Engineering, Sunagawa City Medical Center
  • Sasaki Hayato
    Department of Clinical Engineering, Sunagawa City Medical Center
  • Adachi Isamu
    Department of Clinical Engineering, Sunagawa City Medical Center
  • Shirakawa Kazuki
    Department of Clinical Engineering, Sunagawa City Medical Center
  • Konishi Makiya
    Department of Clinical Engineering, Sunagawa City Medical Center
  • Toyama Ryo
    Department of Clinical Engineering, Sunagawa City Medical Center

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Other Title
  • 血液透析患者のカルシウム・リン代謝における透析液カルシウム濃度の影響
  • ケツエキ トウセキ カンジャ ノ カルシウム リン タイシャ ニ オケル トウセキエキ カルシウム ノウド ノ エイキョウ

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Abstract

The dialysate calcium concentration in hemodialysis has varied with the era of treatment. Recently, Vitamin D and a Ca-containing phosphorus absorbent have frequently been used, and a dialysate calcium concentration of 2.5mEq/L is common. In our hospital, we has used a dialysate calcium concentration of 3.0mEq/L starting in August 2003, and then changed to 2.5mEq/L in September 2008. We analyzed the short-term effects of the change in the dialysate calcium concentration on calcium-phosphorus metabolism in hemodialysis patients. As of September 2008, 81 patients were receiving hemodialysis at our hospital. Those who had undergone hemodialysis for less than 6 months, those whose dialysate calcium concentration was unchanged and those for whom drugs related to calcium-phosphorus metabolism had been changed were excluded. Finally, 52 cases were included in this analysis. We analyzed shifts in serum calcium concentration, serum phosphorus concentration, calcium-phosphorus product and intact PTH after changing the dialysate. Additionally, the change in the rate of achievement of the target levels of serum calcium and phosphorus concentrations in the guideline of the Japanese Society for Dialysis Therapy was analyzed. Eight or more weeks after changing the dialysate, we allowed changes in drugs related to calcium-phosphorus metabolism. After changing the dialysate, serum calcium was decreased, and intact PTH, serum phosphorus and calcium-phosphorus products were significanly increased. As a result, the rate of achieving the target levels of serum calcium and phosphorus concentrations was decreased. However, with changes in drugs, these parameters significantly improved and the achievement rate also improved. Though the dialysate calcium concentration was changed, we could approach target levels of serum calcium and phosphorus by prescribing various agents to manage calcium-phosphorus metabolism.

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