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

Patricia Taschner Goldenstein, Fabiana Giorgeti Graciolli, Gisele Lins Antunes, Wagner Vasques Dominguez, Luciene Machado dos Reis, Sharon Moe, Rosilene Motta Elias, Vanda Jorgetti, Rosa Maria Affonso Moysés

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3 Scopus citations

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.

Original languageEnglish (US)
Article numbere0198946
JournalPloS one
Volume13
Issue number7
DOIs
StatePublished - Jul 2018

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Goldenstein, P. T., Graciolli, F. G., Antunes, G. L., Dominguez, W. V., dos Reis, L. M., Moe, S., Elias, R. M., Jorgetti, V., & Moysés, R. M. A. (2018). A prospective study of the influence of the skeleton on calcium mass transfer during hemodialysis. PloS one, 13(7), [e0198946]. https://doi.org/10.1371/journal.pone.0198946