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Analysis of kinetics of blood ionized calcium during hemodialysis using an i-STAT portable, hand-held blood analyzer.

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  • 血液透析中における血中イオン化カルシウムの動態  ポータブル血液分析器i‐STATを用いた解析

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Abstract

The present study investigated the kinetics of blood ionized calcium (i-Ca) during hemodialysis to develop a nomogram and conversion table for easy calculation of serum total calcium (T-Ca) concentration using the whole blood i-Ca concentration obtained with an i-STAT analyzer.<br>1) Fifty-nine stable ESRD patients were treated with 4-hrs regular hemodialysis treatments using the dialysate, which contained the calcium concentration of 3.0mEq/l (1.5mmol/l). 2) Serum T-Ca concentration increased significantly from 9.43±0.90 (predialysis) to 10.5±0.70mg/dl (postdialysis) (p<0.05). Whole blood i-Ca also increased from 1.26±0.10 to 1.30±0.07mmol/l (p<0.0001). 3) lonized calcium proportion (i-Ca to T-Ca concentration ratio) decreased significantly after dialysis from 53.43±0.03 to 49.55±0.04% (p<0.001). A significant inverse relationship between blood pH and the ionized calcium proportion. 4) We also investigated the relationship between serum T-Ca and whole blood i-Ca concentration before and after dialysis. In predialysis, there was a good relationship between two factors, T-Ca=7.507×i-Ca+0.015 (r=0.839; p<0.001). In postdialysis, however, there was no significant relationship noted. Finally, multiple regression analysis with other factors such as pH and albumin, was required to obtain a significant result; T-Ca=3.369×i-Ca+5.117×pH-32.070 (r=0.436; p=0.0052).<br>In conclusion, measurement of whole blood i-Ca concentration, using the i-STAT portable “point-of-care” analyzer and utilization of the normogram for estimated serum T-Ca concentration are very useful for the diagnosis and treatment of abnormal calcium metabolism in hemodialysis units.

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