Hemodialysis and hemodiafiltration-induced transient hypercalcemia: an unrecognized phenomenon with potential for calcium-loss and vascular calcification
Uremic vascular calcification is prevalent in 70-80% of end-stage kidney disease (ESRD) patients and is an independent predictor of cardiovascular morbidity and mortality. In this study we report our experience with significant transient hypercalcemia during maintenance hemodialysis (HD) in 105 patients and hemodiafiltration (HDF) in another 44 ones. The studied patients had controlled predialysis levels of calcium, phosphorus, 1, 25 vitamin D and parathyroid hormone. Treatment was associated with high dialysate calcium and low serum phosphorus without significant changes in parathyroid hormone levels. Pre-treatment with a single dose of Fosamax; resulted in amelioration of hypercalcemia indicating its bone etiology. In conclusion; maintenance HD and HDF are associated with inherent hypercalcemia which may contribute to osteomalacia and uremic vascular calcification in ESRD patients.
Keywords: Bisphosphonates, HD, HDF, hypercalcemia, hypophosphatemia, osteomalacia, vascular calcification, uremia.
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