Summary
In three patients with stable uraemia the external balance of calcium and phosphate was estimated during hemodialysis with a calcium concentration of 6 mg/100 ml and 8 mg/100 ml in the dialysate, by measuring both ions in the dialysate in 100 routine dialyses.
Dialysis with a dialysate calcium of 6 mg/100 ml and 8 mg/100 ml led to a calcium uptake of 72±36 mg (±SEM,n=63) and 240±52 mg (±SEM,n=34), respectively, phosphate removal decreased significantly from 1019±37 mg to 856±50 mg respectively.
Dialysis with a dialysate calcium of 8 mg/100 ml led to post dialysis hypercalcaemia of 11.5±0.9 mg/100 ml (±SD) which lasted occasionally until the beginning of the next dialysis, the predialysis phosphate levels and predialysis calcium phosphate product decreased significantly with this regimen.
Although most of the induced biochemical changes are not against a dialysate calcium of 8 mg/100 ml, development of marked hypertension in one patient and persistent hypercalcaemia in another one after only five weeks of treatment were reason to abandon the recently suggested use of a dialysate calcium above the concentration of ultrafiltrable serum calcium, especially in the light of the comparatively small net gain of calcium during dialysis.
Zusammenfassung
Aus den Konzentrationsunterschieden von Calcium und Phosphat im Dialysat von 100 Routinedialysen vor und nach der Dialyse wurde der Effekt von unterschiedlichen Dialysatcalciumkonzentrationen auf die Calcium-und Phosphatbilanz von chronisch-intermittierend dialysierten Patienten ermittelt.
Dialyse mit einem Dialysatcalcium von 6 mg-% führte zu einer Calciumaufnahme von 72±36 mg (±SEM,n=63) und zu einem Phosphatentzug von 1019±37 mg (±SEM,n=63). Während der Dialyse mit einem Dialysatcalcium von 8 mg-% stieg die Calciumaufnahme auf 240±52 mg (±SEM,n=34), die Phosphatelimination fiel um denselben Betrag auf 856±50 mg (±SEM,n=34).
Mit einem Dialysatcalcium von 8 mg-% kam es zwar zu einer postdialytischen Hypercalcämie von 11,5±0,9 mg-% (±SD), jedoch wurde ein signifikantes Absinken der prädialytischen Serumphosphatwerte und des für die Entstehung von metastatischen Calcifikationen entscheidenden Calciumphosphatproduktes beobachtet.
Obwohl die Mehrzahl der biochemischen Veränderungen nicht gegen die Verwendung einer höheren Dialysatcalciumkonzentration sprechen würde, wird eine dem ultrafiltrierbaren Serumcalcium entsprechende Dialysatcalciumkonzentration von 6 mg-% empfohlen, nachdem sich bei einem Patienten nach wenigen Wochen der Verwendung einer höheren Dialysatcalciumkonzentration eine ausgeprägte und später reversible Hypertonie, bei einem anderen eine persistierende Hypercalcämie entwickelten.
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Skrabal, F., Dittrich, P. & Gabl, F. Calcium uptake and phosphate removal during hemodialysis with variing dialysate calcium. Klin Wochenschr 52, 266–271 (1974). https://doi.org/10.1007/BF01468456
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DOI: https://doi.org/10.1007/BF01468456