Dialysate calcium concentration ≥ 1.5 mmol/L for most patients treated with intensive HD may not be prudent

In my opinion, one of the biggest mistakes for patients on home dialysis or extended dialysis is to ignore calcium overload by intake (including oral calcium based phosphate binders) or through high dialysate calcium concentration. Do not assume extended dialysis will take care of your calcium overload - in fact it may just do the opposite and cause extensive vascular calcification.

This is the conclusion from a recent study:“In conclusion, to advise a dialysate calcium concentration ≥ 1.5 mmol/L for most patients treated with intensive HD may not be prudent. Furthermore, the statement that this dialysate calcium concentration is not associated with increased risk of vascular or ectopic calcification is inappropriate because of the evidence-based weakness on which it is founded.7, 8, 9, 10”

Dialysate Calcium Concentration and Mineral Metabolism in Long and Long-Frequent Hemodialysis

“Although much of epidemiological and experimental evidence involves the role of elevated serum P level as the main trigger of calcification in CKD, even high level of serum Ca and an elevated Ca x P product may be relevant in the progression of the disease. Sporadic hypercalcemia is quite common in patients who undergo dialysis because of dialysate composition and vitamin D3 and Ca-containing P binders therapies. These episodic spikes of Ca hematic concentration are often undervalued, even if they can be extremely harmful when they are associated with hyperphosphatemia.”

added PDF: https://dl.dropboxusercontent.com/u/44415515/VASCULAR%20CALCIFICATION%20IN%20CHRONIC%20KIDNEY%20DISEASES.pdf