1. Dialysate Calcium
Concentartions
and CKD MBD
Karem Salem.MSc
Ass.lecturer of Nephrology
Theodor Bilharz Research Institute

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Under Supervision of
Dr. Dawlat AbdelHamid Bilal
,Professor of Nephrology, Faculty of Medicine
Cairo University
Dr. Bahaa ElDin Mostafa Zayed
,Ass. Professor of Nephrology, Faculty of Medicine
Cairo University
Dr. Malak Nabil Amin
Lecturer of Nephrology
.Theodor Bilharz Research Institute

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14. Aim of the work
To investigate the relative role of Different
Dialysate Calcium Concentrations on :
1 ) Parathyroid Hormone Levels
2 ) Cardiovascular stability
3 ) Valvular Calcifications

15. Patients and Methods
The study was conducted on 80 ESRD patients
Divided into 2 groups:
Group A: 40 patients With Dialysate Ca concentration of
1.25mmol/L ………………..
Group B: 40 patients With Dialysate Ca concentration of
1.75mmol/L ……………...………….
Patients were on dialysis at least

16. Group (A) : Low Calcium Dialysate

17. Group (B) : High Calcium Dialysate

18. thrice weekly sessions

19. Ultrafiltration

20. Anticoagulation

21. Exclusion Criteria

22. Exclusion Criteria

23. Methods
Thorough history taking and clinical examination.
1) Complete blood count.
2) Kidney Function test
3) Ionized Calcium
4) Serum calcium
5) Serum phosphorus
6) Serum albumin
7) Serum alkaline phosphatase
8) Parathyroid hormone level
9) calcium–phosphorus product (CaxP)

24. 10) ECG
Methods
11) Trans-thoracic
echocardiography.

25. Group A
67.5%
32.5%
Female Male
Group B
40%
60%
Female Male

26. 12.5
10
30
25
Group A Group B
37.5
35
2.5
5
12.5
15
5
10
40
35
30
25
20
15
10
5
0
Percentage
Chronic GN DM HTN Polycystic Unknown Urology

29. Comparison between laboratory data between (Group A) and
(Group B)

30. Group
A B
Valve
Calcified
Aortic 6 10
Mitral 7 10
Both 3 7
None 24 13

31. Comparison between Valvular
calcification between( Group A )and
)(Group B
NS NS
15
25
Group A Group B
17.5
25
7.5
NS
17.5
60
32.5
60
50
40
30
20
10
0
Percentage
S
Aortic Mitral Both None

32. Results
Comparison between Valvular calcification
and Non Valvular calcification patients within Group (A)

33. Results
Comparison between Valvular calcification
and Non Valvular calcification patients within Group (B)

34. 2.97
Group A Group B
2.44 2.52 2.65
3
2.5
2
1.5
1
0.5
0
Mean values
Calcium dose Alphacalcidol dose
P: 0.024
P: 0.051
S NS

35. 77.5
Group A Group B
85
22.5
15
90
80
70
60
50
40
30
20
10
0
Percentage
No Yes
Intradialytic Hypotension
NS

36. Recommendations
To Individualize the dialysate Ca concentrations
(One regimen doesn’t fits all )

37. Recommendations

38. Recommendations

39. Recommendations

40. Recommendations
Don’t forget to do Echocardiography to all
your patients at the initiation
Hemodialysis

41. Recommendations
We recommend to repeat the study on a
Larger number of cases and to include

42. KDOQI Clinical Practice Guidelines
GUIDELINE 9. DIALYSATE CALCIUM
CONCENTRATIONS
9.1 The dialysate calcium concentration in
hemodialysis or peritoneal dialysis should be
1.25 mmol/L. (OPINION)
9.2 Higher or lower dialysate calcium levels are
indicated in selected patients. (OPINION)