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Skeletal and cardiovascular consequences of a positive calcium balance during hemodialysis

Authors :
Rosilene M. Elias
Sharon Moe
Rosa M. A Moysés
Source :
Brazilian Journal of Nephrology, Vol 43, Iss 4, Pp 539-550 (2020)
Publication Year :
2020
Publisher :
Sociedade Brasileira de Nefrologia, 2020.

Abstract

Abstract Patients on hemodialysis are exposed to calcium via the dialysate at least three times a week. Changes in serum calcium vary according to calcium mass transfer during dialysis, which is dependent on the gradient between serum and dialysate calcium concentration (d[Ca]) and the skeleton turnover status that alters the ability of bone to incorporate calcium. Although underappreciated, the d[Ca] can potentially cause positive calcium balance that leads to systemic organ damage, including associations with mortality, myocardial dysfunction, hemodynamic tolerability, vascular calcification, and arrhythmias. The pathophysiology of these adverse effects includes serum calcium changes, parathyroid hormone suppression, and vascular calcification through indirect and direct effects. Some organs are more susceptible to alterations in calcium homeostasis. In this review, we discuss the existing data and potential mechanisms linking the d[Ca] to calcium balance with consequent dysfunction of the skeleton, myocardium, and arteries.

Details

Language :
English, Portuguese
ISSN :
21758239
Volume :
43
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Brazilian Journal of Nephrology
Publication Type :
Academic Journal
Accession number :
edsdoj.3315051a76465382ee5c4cb39e5e92
Document Type :
article
Full Text :
https://doi.org/10.1590/2175-8239-jbn-2020-0098