A Study of Serum Calcium in Maintenance Haemodialysis Patient

Background: To define the minimum and maximum levels for calcium concentration of dialysis fluid a combination of acute and long-term observations was carried out. The external calcium balance during dialysis was dependent on the gradient between plasma ultra filterable calcium and dialysis fluid calcium concentration. Changes in plasma calcium during dialysis did not correlate with measured external balance. The maximum level for the calcium concentration of the dialysis fluid is therefore the highest which does not cause complications due to the transient hypercalcaemia.

Methods: This study was a cross sectional study. This study was taken place in the haemodialysis unit of National Institute of Kidney Disease and Urology (NIKDU) and Bangladesh Institute of Research & Rehabilitation on Diabetes, Endocrine and Metabolism (BIRDEM). Patients getting maintenance haemodialysis in NIKDU and also BIRDEM were enrolled in this study. Dialysate calcium concentration was 1.8 mmol/L.

Results: Laboratory findings of the study patients, it was observed that mean serum calcium was found 8.77±0.98 mg/dl. Achievement of the four recommendations of K/DOQI guidelines was only 9(7.5%). Laboratory findings of the study patients showed that 9 patients had ≥ 10.2 mg/dl serum calcium, among them 3(33.3%) received Vitamin D. Drug history related to calcium supplementation regarding serum calcium level, it was observed that 39 patients had < 8.4 mg/dl serum calcium level. Among them 25(64.1%) patients use calcium supplementation. The percentages of patients (no drug history related vitamin D) who received dialysis twice & thrice per week and within the target range of levels were as follows: serum calcium: 73.1% & 57.6% respectively.

Conclusion: Higher levels of calcium containing dialysate that is used in Bangladesh; irrational use of drug related to calcium based phosphate binder and Calcitriol- these may becauses of over suppression of parathyroid hormone (PTH) which is reflected in this study patients getting MHD twice or thrice weekly.