A prospective study of the influence of the skeleton on calcium mass transfer during hemodialysis

Author(s)

Goldenstein, Patricia Taschner ^[1] ; Graciolli, Fabiana Giorgeti ^[1] ; Antunes, Gisele Lins ^[1] ; Dominguez, Wagner Vasques ^[1] ; dos Reis, Luciene Machado ^[1] ; Moe, Sharon ^{[2, 3]} ; Elias, Rosilene Motta ^{[1, 4]} ; Jorgetti, Vanda ^[1] ; Affonso Moyses, Rosa Maria ^{[1, 4]}

Affiliation

^[1] Univ Sao Paulo, Nephrol Div, Sao Paulo - Brazil

^[2] Indiana Univ Sch Med, Indianapolis, IN 46202 - USA

^[3] Richard L Roudebush Vet Adm Med Ctr, Indianapolis, IN - USA

^[4] Univ Nove Julho UNINOVE, Med Master Degree Program, Sao Paulo - Brazil

• Document type: Journal article
• Source: PLoS One; v. 13, n. 7 JUL 30 2018.
• Web of Science Citations: 1

Abstract

Background Calcium gradient, the difference between serum calcium and dialysate calcium d{[}Ca], is the main contributor factor influencing calcium transfer during hemodialysis. The impact, however, of bone turnover, on calcium mass transfer during hemodialysis is still uncertain. Methods This prospective cross-sectional study included 10 patients on hemodialysis for a 57.6 +/- 16.8 months, with severe hyperparathyroidism. Patients were submitted to 3 hemodialysis sessions using d{[}Ca] of 1.25, 1.5 and 1.75 mmol/l in three situations: pre-parathyroidectomy (pre-PTX), during hungry bone (early post-PTX), and after stabilization of clinical status (late post-PTX). Biochemical analysis and calcium mass transfer were evaluated and serum bone-related proteins were quantified. Results Calcium mass transfer varied widely among patients in each study phase with a median of -89.5, -76.8 and -3 mmol using d{[}Ca] 1.25 mmol/L, -106, -26.8 and 29.7 mmol using d{[}Ca] 1.50 mmol/L, and 12.8, -14.5 and 38 mmol using d{[}Ca] 1.75 mmol/L during pre-PTX, early post-PTX and late post-PTX, respectively, which was significantly different among d{[}Ca] (p = 0.0001) and among phases (p = 0.040). Ca gradient and delta of Ca also differed among d {[}Ca] and phases (p<0.05 for all comparisons), whether ultrafiltration was similar. Serum Osteocalcin decreased significantly in late post-PTX, whereas Sclerostin increased earlier, in early post-PTX. Conclusions The skeleton plays a key role in Ca mass transfer during dialysis, either by determining pre-dialysis serum Ca or by controlling the exchangeable Ca pool. Knowing that could help us to decide which d{[}Ca] should be chosen in a given patient. (AU)

• FAPESP's process: 10/20549-9 - Impact of bone remodeling on calcium mass transfer during hemodialysis: a study in patients with hyperparathyroidism before and after parathyroidectomy
• Grantee: Rosa Maria Affonso Moysés
• Support Opportunities: Regular Research Grants