Skip to main content
SpringerLink
Log in

Dialysate calcium and plasma calcium fractions during and after haemodialysis

Dialysat-Calcium und Plasma-Calciumfraktionen während und nach Hämodialysebehandlung

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

Dialysate Calcium and Plasma Calcium Fractions during and after Haemodialysis:

The effect of different dialysate Ca concentrations on the plasma Ca fractions was examined in 28 patients. In 10 patients dialysed with a dialysate Ca concentration of 3.0 mEq/l the Ca fractions were determined at the start and end of dialysis. 8 patients were dialysed with dialysate Ca of 3.5 mEq/l. In this group the Ca fractions were also estimated in the dialysis-free interval. The third group was dialysed with a dialysate Ca of 4.5 mEq/l. Total calcium and protein-bound calcium rose significantly in all groups. Ionised calcium in the first group was significantly reduced, in the second group it remained constant and in the third group it was significantly raised. Since parathyroid function depends on the plasma ionised calcium it is concluded that a dialysate concentration of 3.0 mEq/l is partly responsible for the pathogenesis of secondary hyperparathyroidism and of renal osteodystrophy. In normocalcaemic patients a dialysate Ca concentration of 3.5 to 4.0 mEq/l is optimal. In patients entering long-term haemodialysis treatment with pronounced calcium deficiency symptoms a dialysate Ca of up to 4.5 mEq/l may be indicated for a short period after having normalized the inorganic phosphate levels in order to prevent extraosseous calcification.

Zusammenfassung

Der Einfluß verschiedener Dialysat-Ca-Konzentrationen auf die Plasma-Ca-Fraktionen wurde bei 28 Dialysepatienten untersucht. Bei 10 Dialysen mit einem Dialysat-Ca von 3,0 mval/l wurden die Ca-Fraktionen am Anfang und Ende der Dialyse bestimmt. In einer zweiten Gruppe mit 8 Patienten betrug der Dialysat-Ca-Gehalt 3,5 mval/l; hier wurden die Ca-Fraktionen auch im dialysefreien Intervall bestimmt. Bei der dritten Gruppe lag der Dialysat-Ca-Gehalt bei 4,5 mval/l.

Gesamt-Ca und proteingebundenes Ca stiegen in allen Gruppen signifikant an. Ionisiertes Calcium fiel in der ersten Gruppe signifikant ab, blieb in der zweiten Gruppe konstant und stieg in der dritten Gruppe signifikant an. Da die Ausschüttung von Parathormon entscheidend abhängig ist vom ionisierten Calcium im Plasma, wird gefolgert, daß ein Dialysat-Ca-Gehalt von 3,0 mval/l für die Pathogenese des sekundären Hyperparathyreoidismus und der renalen Osteodystrophie mitverantwortlich ist. Bei normocalcämischen Patienten ist ein Dialysat-Ca von 3,5–4,0 mval/l angemessen. Bei Patienten mit ausgeprägter Calcium-Mangelsymptomatik dürfte kurzfristig auch die Verwendung eines Dialysat-Ca von 4,5 mval/l angezeigt sein, dies aber nur nach Normalisierung des Serumphosphatspiegels zur Prävention extraossärer Verkalkungen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Berlyne, G. M., Ben-Ari, J., Epstein, N., Booth EM, Yagil R.: Rarity of renal osteodystrophy in Israel due to low phosphorus intake. Nephron10, 141–156 (1973)

    PubMed  Google Scholar 

  2. Slatopolsky, E., Bricker, N. S.: The role of phosphorus restriction in the prevention of secondary hyperparathyroidism in chronic renal disease. Kidney Internat.4, 141–145 (1973)

    Google Scholar 

  3. Barzel, U. S., Hart, H.: Studies in calcium absorption: initial entry of calcium into the gastrointestinal tract in hyperparathyroidism and in a case of renal tubular acidosis. Nephron10, 174–187 (1973)

    Google Scholar 

  4. Hesch, R. D., Gerlach, W., Henning, H. V., Emrich, D., Scheler, F., Kattermann, R.: Untersuchungen zur interstinalen47Ca-Absorption bei Gesunden und Patienten mit chronischer Niereninsuffizienz. Dtsch. med. Wschr.97, 1735–1742 (1972)

    PubMed  Google Scholar 

  5. Freeman, R. B., Maher, J. F., Schreiner, G. E.: The affinity of synthetic membranes for calcium. Trans. Amer. Soc. Artif. Int. Organs11, 99–103 (1965)

    Google Scholar 

  6. Goldsmith, R. S., Furszyfer, J., Johnson, W. J., Fournier, A. E., Arnaud, C. D.: Control of secondary hyperparathyroidism during long-term hemodialysis. Amer. J. Med.50, 692–699 (1971)

    PubMed  Google Scholar 

  7. Wing, A. J.: Optimum calcium concentration of dialysis fluid for maintenance haemodialysis. Brit. med. J.4, 145–149 (1968)

    PubMed  Google Scholar 

  8. Fournier, A. E., Johnson, W. J., Taves, D. R., Beabout, J. W., Arnaud, C. D., Goldsmith, R. S.: Etiology of hyperparathyroidism and bone disease during chronic hemodialysis I. Association of bone disease with potentially etiologic factors. J. clin. Invest.50, 592–598 (1971)

    PubMed  Google Scholar 

  9. Fournier, A. E., Arnaud, C. D., Johnson, W. J., Taylor, W. F., Goldsmith, R. S.: Etiology of hyperparathyroidism and bone disease during chronic hemodialysis. II. Factors affecting serum immunoreactive parathyroid hormone. J. clin. Invest.50, 599–605 (1971)

    PubMed  Google Scholar 

  10. Schulz, W., Delling, G., Stoian, L., Schulz, A., Gessler, U.: Ausmaß und Entwicklung der renalen Osteopathie — Vergleichende klinische und histomorphometrische Untersuchungen an Patienten mit chronischer Nierensuffizienz mit und ohne Hämodialyse. Nieren- und Hochdruckkrankheiten (in press)

  11. Paschen, K., Fuchs, C.: A new micro-method for Na, K, Ca, and Mg determinations in a single serum dilution by atomic-absorption spectrophotometry. Clin. chim. Acta35, 401–408 (1971)

    PubMed  Google Scholar 

  12. Quellhorst, E., Plashues, E.: Ultrafiltation: Elimination harnpflichtiger Substanzen mit Hilfe neuartiger Membranen. In: Symposion über aktuelle Probleme der Dialyseverfahren und der Niereninsuffizienz, edit. by v. Dittrich, P., Skrabal, F., Friedberg/Hessen, GFR, Bindernagel 1972, p. 216–226

    Google Scholar 

  13. Fuchs, C., Paschen, K., Spieckermann, P. G., v. Westberg, C,: Determination of ionized calcium in serum with an ionselective flow-thru-electrode: Method and normal values. Klin. Wschr.50, 824–832 (1972)

    PubMed  Google Scholar 

  14. Arnaud, C. D.: Hyperparathyroidism and renal failure. Kidney Internat.4, 89–95 (1973)

    Google Scholar 

  15. De Luca, H. F.: The kidney as an endocrine organ involved in calcium homeostasis. Kidney Internat.4, 80–88 (1973)

    Google Scholar 

  16. Goldsmith, R. S., Johnson, W. J.: Role of phosphate depletion and high dialysate calcium in controlling dialytic renal osteodystrophy. Kidney Internat.4, 154–160 (1973)

    Google Scholar 

  17. Kaye, M., Cohen, G. F., Chatterjee, G., Mangel, R.: Regulation of the plasma ionized calcium and its therapeutic control in patients treated by regular hemodialysis. Trans. Amer. Soc. Artif. Int. Organs.15, 341–345 (1969)

    Google Scholar 

  18. Pedersen, K. O.: The effect of bicarbonate, pCO2 and pH on serum calcium fractions. Scand. J. clin. Lab. Invest.27, 145–150 (1971)

    PubMed  Google Scholar 

  19. Berlyne, G. M., Ben-Ari, J., Pest, D., Weinberger, J., Stern, M., Gilmore, G. R., Levine, R.: Hyperaluminaemia from aluminium resins in renal failure. Lancet1970, 494–496

  20. Berlyne, G. M., Yagil, R., Ben-Ari, J., Weinberger, G., Knopf, E., Danovitch, G. M.: Aluminium toxicity in rats. Lancet1972, 546–568

  21. Fuchs, C., Brasche, M., Nordbeck, H., Quellhorst, E.: Aluminium determination in serum by flameless atomic absorption. Clin. chim. Acta52, 71–80 (1974)

    PubMed  Google Scholar 

  22. Bone, J. M., Davison, A. M., Robson, J. S.: Role of dialysate calcium concentration in osteoporosis patients on haemodialysis. Lancet1972, 1047–1049

  23. Denney, J. D., Sherrard, D. J., Nelp, W. B., Chesnu III, C. H., Baylink, D. J.: Total body calcium and long-term calcium balance in chronic renal disease. J. Lab. clin. Med.82, 226–240 (1973)

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Physiology I and Department of Nephrology, Medical Clinics, University of Goettingen, German Federal Republic

    Chr Fuchs, M. Brasche, Uta Donath-Wolfram, J. Kubosch, E. Quellhorst & F. Scheler

  2. Nephrologisches Zentrum Niedersachsen, Hannoversch-Muenden, German Federal Republic

    Chr Fuchs, M. Brasche, Uta Donath-Wolfram, J. Kubosch, E. Quellhorst & F. Scheler

Authors
  1. Chr Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Brasche
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Uta Donath-Wolfram
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Kubosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Quellhorst
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Scheler
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fuchs, C., Brasche, M., Donath-Wolfram, U. et al. Dialysate calcium and plasma calcium fractions during and after haemodialysis. Klin Wochenschr 53, 39–42 (1975). https://doi.org/10.1007/BF01466855

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01466855

Key words

Schlüsselwörter

Search

Navigation