Dialysate Calcium Concentartionsand CKD MBD

Karem Salem.MScAss.lecturer of Nephrology

Theodor Bilharz Research Institute

The Effect of Different Dialysate Calcium The Effect of Different Dialysate Calcium Concentrations on Parathyroid Hormone Concentrations on Parathyroid Hormone

Levels in end stage renal disease patients Levels in end stage renal disease patients on regular hemodialysison regular hemodialysis

Under Supervision ofDr. Dawlat AbdelHamid BilalProfessor of Nephrology, Faculty of Medicine,

Cairo University

Dr. Bahaa ElDin Mostafa Zayed Ass. Professor of Nephrology, Faculty of Medicine,

Cairo University

Dr. Malak Nabil Amin Lecturer of Nephrology

Theodor Bilharz Research Institute.

??

Aim of the work

To investigate the relative role of Different

Dialysate Calcium Concentrations on :

1 ) Parathyroid Hormone Levels

2 ) Cardiovascular stability

3 ) Valvular Calcifications

Patients and Methods

The study was conducted on 80 ESRD patients

Divided into 2 groups:

Group A: 40 patients With Dialysate Ca concentration of 1.25mmol/L ………………..

Group B: 40 patients With Dialysate Ca concentration of 1.75mmol/L ……………...………….

Patients were on dialysis at least

Group (A) : Low Calcium Dialysate

Group (B) : High Calcium Dialysate

thrice weekly sessions

Ultrafiltration

Anticoagulation

Exclusion Criteria

Exclusion Criteria

Methods

Thorough history taking and clinical examination.1) Complete blood count.2) Kidney Function test 3) Ionized Calcium 4) Serum calcium 5) Serum phosphorus 6) Serum albumin7) Serum alkaline phosphatase8) Parathyroid hormone level 9) calcium–phosphorus product (CaxP)

10) ECG

11) Trans-thoracic

echocardiography.

Methods

Group A

67.5%

32.5%

Female Male

Group B

40%

60%

Female Male

12.510

30

25

37.535

2.55

12.515

5

10

0

5

10

15

20

25

30

35

40

Pe

rce

nta

ge

Chronic GN DM HTN Polycystic Unknown Urology

Group A Group B

Comparison between laboratory data between (Group A) and (Group B)

Group

A BValve Calcified

Aortic6 10

Mitral7 10

Both3 7

None24 13

Comparison between Valvular calcification between( Group A )and

(Group B)

15

25

17.5

25

7.5

17.5

60

32.5

0

10

20

30

40

50

60

Per

cen

tag

e

Aortic Mitral Both None

Group A Group B

NS NSNS

S

Results

Comparison between Valvular calcification and Non Valvular calcification patients within Group (A)

Results

Comparison between Valvular calcification

and Non Valvular calcification patients within Group (B)

2.97

2.44 2.522.65

0

0.5

1

1.5

2

2.5

3

Mean

valu

es

Calcium dose Alphacalcidol dose

Group A Group B

P: 0.024

P: 0.051

S NS

77.585

22.515

0

10

20

30

40

50

60

70

80

90

Pe

rce

nta

ge

No Yes

Intradialytic Hypotension

Group A Group B

NS

RecommendationsTo Individualize the dialysate Ca concentrations

(One regimen doesn’t fits all )

Recommendations

Recommendations

Recommendations

RecommendationsDon’t forget to do Echocardiography to all

your patients at the initiation Hemodialysis

RecommendationsWe recommend to repeat the study on a Larger number of cases and to include

KDOQI Clinical Practice Guidelines

GUIDELINE 9. DIALYSATE CALCIUM CONCENTRATIONS9.1 The dialysate calcium concentration in hemodialysis or peritoneal dialysis should be 1.25 mmol/L. (OPINION)9.2 Higher or lower dialysate calcium levels are indicated in selected patients. (OPINION)