Low calcium dialysate combined with CaCO(3) in hyperphosphatemia in hemodialysis patients

This aim of this study was to observe the effects of the application of low calcium dialysate (LCD) combined with oral administration of CaCO(3) in the treatment of hyperphosphatemia, as well as blood Ca(2+), calcium-phosphate product (CPP), parathyroid hormone (PTH) and blood pressure in patients undergoing hemodialysis. Thirty-one maintenance hemodialysis (MHD) patients with hyperphosphatemia, but normal blood Ca(2+), underwent dialysis with an initial dialy-sate Ca(2+) concentration (DCa) of 1.50 mmol/l for six months and then with 1.25 mmol/l for six months. The patients who underwent dialysis with a DCa of 1.25 mmol/l were treated orally with 0.3 g CaCO(3) tablets three times a day. In the third and sixth months [observation end point (OEP)] of the dialysis, the concentrations of Ca(2+), phosphorus and intact PTH (iPTH) were measured; blood pressure and side-effects prior to and following dialysis were also observed. The Ca(2+), CPP and iPTH levels increased (P<0.05) in the sixth month of treatment with a DCa of 1.50 mmol/l. However, the Ca(2+) concentration declined to a certain degree, CPPs decreased significantly (P<0.05) and the iPTH concentration increased following treatment with a DCa of 1.25 mmol/l for six months. The incidence rate of adverse effects of LCD was 12.9% (4/31); the effects were mainly muscle spasms, hypotension and elevated PTH. The periodic application of LCD combined with the oral administration of CaCO(3) effectively reduced serum phosphorus and CPPs among MHD patients with hyperphosphatemia, indicating that the treatment may be used clinically.