New data suggest that a fall in parathyroid hormone (PTH) 12 months after initiating haemodialysis is associated with cardiovascular death at 12–24 months. The main independent predictor for the fall in PTH is a high dialysate calcium concentration, which might not only reduce PTH but also induce vascular calcification.
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References
Paloian, N. J. & Giachelli, C. M. A current understanding of vascular calcification in CKD. Am. J. Physiol. Renal Physiol. 307, F891–F900 (2014).
Bushinsky, D. A. Contribution of intestine, bone, kidney, and dialysis to extracellular fluid calcium content. Clin. J. Am. Soc. Nephrol. 5, S12–S22 (2010).
Merle, E. et al. Low parathyroid hormone status induced by high dialysate calcium is an independent risk factor of cardiovascular death in haemodialysis patients. Kidney Int. 89, 666–674 (2016).
Investigators, E. T. et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N. Engl. J. Med. 367, 2482–2494 (2012).
Hill, K. M. et al. Oral calcium carbonate affects calcium but not phosphorus balance in stage 3–4 chronic kidney disease. Kidney Int. 83, 959–966 (2013).
Spiegel, D. M. & Brady, K. Calcium balance in normal individuals and in patients with chronic kidney disease on low- and high-calcium diets. Kidney Int. 81, 1116–1122 (2012).
Hou, S. H. et al. Calcium and phosphorus fluxes during hemodialysis with low calcium dialysate. Am. J. Kidney Dis. 18, 217–224 (1991).
Patel, L., Bernard, L. M. & Elder, G. J. Sevelamer versus calcium-based binders for treatment of hyperphosphatemia in CKD: a meta-analysis of randomized controlled trials. Clin. J. Am. Soc. Nephrol. 11, 232–244 (2015).
Reid, I. R., Bristow, S. M. & Bolland, M. J. Calcium supplements: benefits and risks. J. Intern. Med. 278, 354–368 (2015).
Ok, E. et al. Reduction of dialysate calcium level reduces progression of coronary artery calcification and improves low bone turnover in patients on hemodialysis. J. Am. Soc. Nephrol. http://dx.doi.org/10.1681/ASN.2015030268 (2015).
Acknowledgements
W.C. is supported in part by an NIH grant (grant number KL2 TR000095). D.A.B. is supported in part by an NIH grant (number 2R01DK075462). Both researchers receive grant support from the Renal Research Institute.
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D.A.B. is a consultant for Relyspa, Amgen, Sanofi/Genzyme, and Tricida and has equity interest in Relypsa, Amgen and Tricida. W.C. declares no competing interests.
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Chen, W., Bushinsky, D. The perils of a falling PTH due to high dialysate calcium. Nat Rev Nephrol 12, 264–266 (2016). https://doi.org/10.1038/nrneph.2016.36
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DOI: https://doi.org/10.1038/nrneph.2016.36