Intradialytic alkalinization is a neglected factor affecting calcium mass balance and parathyroid hormone level during haemodiafiltration

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064203%3A_____%2F19%3A10394628" target="_blank" >RIV/00064203:_____/19:10394628 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11110/19:10394628

Výsledek na webu

<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=-8sWxBtBBE" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=-8sWxBtBBE</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1093/ckj/sfy047" target="_blank" >10.1093/ckj/sfy047</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Intradialytic alkalinization is a neglected factor affecting calcium mass balance and parathyroid hormone level during haemodiafiltration

Popis výsledku v původním jazyce

Background The diffusion gradient between ionized calcium (iCa) in the inlet dialysate and blood is considered to be the main driving force of calcium mass balance (CMB). The intradialytic change of parathyroid hormone (PTH) level corresponds to the change in plasma iCa. In contrast to the widely discussed calcium concentration of dialysis solution, the dialysate pH and bicarbonate concentration (DHCO3), important factors affecting the level of iCa, have not been studied with respect to the intradialytic change of plasma PTH level (PTH) and CMB. Methods We measured PTH and CMB (calcium flux from the dialysate to the patient) in 10 stable patients on haemodiafiltration. All patients underwent two treatments differing in DHCO3 (26 versus 32mmol/L). The dialysate calcium concentration was 1.25mmol/L for all treatments. Results We found significant difference in PTH, which decreased with 26_DHCO3 and slightly increased with 32_DHCO3 (-110.5 versus+19.7pg/mL, P&lt;0.01). CMB was negative for both DHCO3, but with higher DHCO3 there was a trend to minor intradialytic loss of calcium (-108 versus -309mg). Conclusions DHCO3 increase at first glance leads to contrasting phenomena: the intradialytic rise of PTH and calcium gain. Both processes are caused by a pH-dependent decrease of plasma iCa, resulting in parathyroid stimulation and intradialytic increase of iCa diffusion gradient. We found no significant correlation between CMB and intradialytic change of plasma total Ca. With respect to plasma PTH level and CMB, the bicarbonate concentration should always be taken into account when selecting the optimal dialysis solution.

Název v anglickém jazyce

Intradialytic alkalinization is a neglected factor affecting calcium mass balance and parathyroid hormone level during haemodiafiltration

Popis výsledku anglicky

Background The diffusion gradient between ionized calcium (iCa) in the inlet dialysate and blood is considered to be the main driving force of calcium mass balance (CMB). The intradialytic change of parathyroid hormone (PTH) level corresponds to the change in plasma iCa. In contrast to the widely discussed calcium concentration of dialysis solution, the dialysate pH and bicarbonate concentration (DHCO3), important factors affecting the level of iCa, have not been studied with respect to the intradialytic change of plasma PTH level (PTH) and CMB. Methods We measured PTH and CMB (calcium flux from the dialysate to the patient) in 10 stable patients on haemodiafiltration. All patients underwent two treatments differing in DHCO3 (26 versus 32mmol/L). The dialysate calcium concentration was 1.25mmol/L for all treatments. Results We found significant difference in PTH, which decreased with 26_DHCO3 and slightly increased with 32_DHCO3 (-110.5 versus+19.7pg/mL, P&lt;0.01). CMB was negative for both DHCO3, but with higher DHCO3 there was a trend to minor intradialytic loss of calcium (-108 versus -309mg). Conclusions DHCO3 increase at first glance leads to contrasting phenomena: the intradialytic rise of PTH and calcium gain. Both processes are caused by a pH-dependent decrease of plasma iCa, resulting in parathyroid stimulation and intradialytic increase of iCa diffusion gradient. We found no significant correlation between CMB and intradialytic change of plasma total Ca. With respect to plasma PTH level and CMB, the bicarbonate concentration should always be taken into account when selecting the optimal dialysis solution.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30217 - Urology and nephrology

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2019

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Clinical Kidney Journal

ISSN

2048-8505

e-ISSN

—

Svazek periodika

12

Číslo periodika v rámci svazku

1

Stát vydavatele periodika

GB - Spojené království Velké Británie a Severního Irska

Počet stran výsledku

8

Strana od-do

149-156

Kód UT WoS článku

000469506700023

EID výsledku v databázi Scopus

2-s2.0-85054762909