dialysate calcium concentartions and ckd mbd dr. karem salem
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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
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)
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 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
RecommendationsDon’t forget to do Echocardiography to all
your patients at the initiation Hemodialysis
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)