UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK.
Artif Organs. 2024 Aug;48(8):812-820. doi: 10.1111/aor.14802. Epub 2024 Jun 4.
Debate continues as to the optimum hemodialysis (HD) dialysate calcium concentration. Although current guidelines advocate 1.25-1.5 mmol/L, some investigators have suggested these may cause calcium gains. As such we investigated whether using dialysate calcium of 1.25 mmol/L risked calcium gains, and whether there were differences between hemodiafiltration and high flux HD.
We continuously collect an aliquot of effluent dialysate during dialysis sessions, and calculated dialysis calcium mass balance by the difference between the amount of calcium delivered as fresh dialysate and that lost in effluent dialysate.
We studied 106 stable outpatients, 64% male, mean age 64.4 ± 16.2 years, median dialysis vintage 32 (22-60) months. Most sessions (69%) used a 1.0 mmol/L calcium dialysate, with a median sessional loss of 13.7 (11.5-17.1) mmol, whereas using 1.25 mmol/L the median loss was 7.4 (4.9-10.1) mmol, but with 6.9% had a positive balance (p = 0.031 vs dialysate calcium 1.0 mmol/L). Most patients (85.8%) were treated by hemodiafiltration, but there was no difference in sessional losses (11.7 (8.4-15.8) vs 13.5 (8.1-16.8)) with high flux HD. Dialysis sessional calcium balance was associated with the use of lower dialysate calcium concentration (β -19.5, 95% confidence limits (95%CL) -27.7 to -11.3, p < 0.001), and sessional duration (β 0.07 (95% CL) 0.03-012, p = 0.002).
Ideally, the choice of dialysate calcium should be individualized, but clinicians should be aware, that even when using a dialysate calcium of 1.25 mmol/L, some patients are at risk of a calcium gain during hemodiafiltration and high-flux hemodialysis.
关于最佳血液透析（HD）透析液钙浓度，争议仍在继续。尽管目前的指南主张使用 1.25-1.5mmol/L，但一些研究人员认为这些浓度可能导致钙的增加。因此，我们研究了使用 1.25mmol/L 透析液钙是否会有钙的增加风险，以及血液透析滤过和高通量血液透析之间是否存在差异。
我们在透析过程中连续收集透析液的等分试样，并通过新鲜透析液中输送的钙量与透析液中损失的钙量之间的差值计算透析钙质量平衡。
我们研究了 106 例稳定的门诊患者，其中 64%为男性，平均年龄 64.4±16.2 岁，中位透析龄 32（22-60）个月。大多数透析方案（69%）使用 1.0mmol/L 钙透析液，中位透析液损失量为 13.7（11.5-17.1）mmol，而使用 1.25mmol/L 时，中位损失量为 7.4（4.9-10.1）mmol，但有 6.9%的患者出现正钙平衡（p=0.031 与 1.0mmol/L 钙透析液相比）。大多数患者（85.8%）接受血液透析滤过治疗，但高通量血液透析时，透析液损失量无差异（11.7（8.4-15.8）与 13.5（8.1-16.8））。透析液钙平衡与使用较低的透析液钙浓度（β-19.5，95%置信区间（95%CL）-27.7 至-11.3，p<0.001）和透析时间（β0.07（95%CL）0.03-0.12，p=0.002）相关。
理想情况下，透析液钙的选择应个体化，但临床医生应注意，即使使用 1.25mmol/L 的透析液钙，在血液透析滤过和高通量血液透析中，一些患者仍有发生钙增加的风险。
