Dermatosis perforante adquirida en pacientes con insuficiencia renal crónica. Presentación de dos casos y revisión de la literatura / Acquired perforating dermatosis in patients with chronic renal failure. A report of two cases and a review of the literature

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Individualización del calcio en el baño de diálisis: una asignatura pendiente / Dialysate calcium individualisation: a pending issue

Introducción: El calcio (Ca) es uno de los elementos fundamentales a tener en cuenta en los pacientes en diálisis, dada su relación con el riesgo cardiovascular. Con la introducción de los modernos quelantes del fósforo no cálcicos y de los calcimiméticos, hemos visto variar la calcemia prehemodiálisis, en los últimos años, de 9,5-10,5 a 8,4-9,5 mg/dl. Para valorar de una forma más precisa las variaciones del Ca durante la sesión de hemodiálisis e individualizar su prescripción, el objetivo del estudio fue comparar diferentes concentraciones de Ca en el baño de diálisis, valorando el balance pre y poshemodiálisis y sus implicaciones en el control del metabolismo fosfocálcico. Pacientes y métodos: Se incluyeron 98 pacientes con una edad media de 59,3 ± 15 años, 68 hombres y 30 mujeres. Cada paciente se sometió a dos sesiones de hemodiálisis variando únicamente la concentración de Ca del baño, una sesión con Ca 2,5 mEq/L (grupo Ca25) y otra con Ca 3,0 mEq/L (grupo Ca30). Se determinaron los niveles de Ca, fósforo (P) y paratohormona (PTH) pre y poshemodiálisis, registrando la medicación relacionada. Además se dividieron los pacientes en cuatro subgrupos según los niveles de calcemia prediálisis en Ca < 8,5, 8,5-9,0, 9,0-9,5 y > 9,5 mg/dl para realizar un análisis más individualizado. Resultados: No se observaron diferencias en los valores prediálisis de Ca, 8,81 ± 0,65 (Ca25) y 8,88 ± 0,61 (Ca30); P, 4,01 ± 1,3 (Ca25) y 4,19 ± 1,2 (Ca30); y PTH, 352 ± 288 (Ca25) y 369 ± 310 (Ca30). Con el baño Ca25, el Ca y la PTH posdiálisis no se modificaron significativamente, mientras que con el Ca30 se observó un incremento significativo del Ca a 10,2 ± 0,6 (p < 0,001) acompañado de un descenso de la PTH (181 ± 227, p < 0,001). No obstante, cuando se analizaba el baño Ca25 por subgrupos de Ca prediálisis (< 8,5 mg/dl [30,6%], 8,5-9,0 [31,6%], 9,1-9,5 [23,5%] y > 9,5 mg/dl [14,3%]), se apreció un aumento del Ca posdiálisis en los (AU)

Calcium is one of the key elements to consider in patients on dialysis due to its relationship with cardiovascular risk. The introduction of non-calcium-based phosphate binders and calcimimetics has changed the setting for pre-dialysis serum calcium in recent years from 9.5-10.5mg/dl to 8.5-9.5mg/dl. To assess more accurately the changes in calcium (Ca) during haemodialysis sessions and to individualise prescriptions, the aim of this study was to assess the intradialytic changes of two different dialysate Ca concentrations before and after hemodialysis and their implications in controlling calcium-phosphate metabolism. Patients and method: We analysed 98 patients with a mean age of 59.3±15 years, 68 of which were men and 30 women. Each patient received two HD sessions with two different dialysate Ca concentrations: 2.5mEq/l (Ca25 group) or 3.0mEq/l (Ca30 group). Pre- and post-dialysis Ca, phosphorus (P) and PTH were determined, and associated medications were recorded. For a more individualised analysis, patients were divided into four subgroups of Ca<8.5mg/dl, 8.5-9.0mg/dl, 9.0-9.5mg/dl, and >9.5mg/dl, according to pre-dialysis serum calcium levels. Results: There were no differences in pre-dialysis values of Ca: 8.81±0.65 (CA25) and 8.88±0.61 (CA30), P: 4.01±1.3 (CA25) and 4.19±1.2 (CA30), or PTH: 352±288 (CA25) and 369±310 (CA30). Post-dialysis Ca and PTH did not change significantly with CA25 dialysate, although there was a significant post-dialysis Ca increase to (AU)

Dialysate calcium individualisation: a pending issue.

UNLABELLED: Calcium is one of the key elements to consider in patients on dialysis due to its relationship with cardiovascular risk. The introduction of non-calcium-based phosphate binders and calcimimetics has changed the setting for pre-dialysis serum calcium in recent years from 9.5-10.5mg/dl to 8.5-9.5mg/dl. To assess more accurately the changes in calcium (Ca) during haemodialysis sessions and to individualise prescriptions, the aim of this study was to assess the intradialytic changes of two different dialysate Ca concentrations before and after hemodialysis and their implications in controlling calcium-phosphate metabolism. PATIENTS AND METHOD: We analysed 98 patients with a mean age of 59.3 ± 15 years, 68 of which were men and 30 women. Each patient received two HD sessions with two different dialysate Ca concentrations: 2.5 mEq/l (Ca25 group) or 3.0 mEq/l (Ca30 group). Pre- and post-dialysis Ca, phosphorus (P) and PTH were determined, and associated medications were recorded. For a more individualised analysis, patients were divided into four subgroups of Ca<8.5mg/dl, 8.5-9.0mg/dl, 9.0-9.5mg/dl, and >9.5mg/dl, according to pre-dialysis serum calcium levels. RESULTS: There were no differences in pre-dialysis values of Ca: 8.81 ± 0.65 (CA25) and 8.88 ± 0.61 (CA30), P: 4.01 ± 1.3 (CA25) and 4.19 ± 1.2 (CA30), or PTH: 352 ± 288 (CA25) and 369 ± 310 (CA30). Post-dialysis Ca and PTH did not change significantly with CA25 dialysate, although there was a significant post-dialysis Ca increase to 10.2 ± 0.6 (P<.001) accompanied by a decrease in post-dialysis PTH (181 ± 227, P<.001) with CA30. However, with CA25 dialysate, when different subgroups of pre-dialysis Ca were analysed: <8.5mg/dl (30.6%), 8.5-9.0mg/dl (31.6%), 9.1-9.5mg/dl (23.5%) and >9.5mg/dl (14.3%) we observed a Ca increase during the session in the <8.5 (P<.001) and 8.5-9.0 (P<.01) subgroups. Ca was unchanged in the 9.1-9.5 group and Ca decreased when the initial Ca values were >9.5mg/dL (P<.01). A Ca increase (P<.001) and a decrease in PTH (P<.01) were observed in all subgroups with CA30 dialysate. A total of 42% of patients were taking calcimimetics, 47% paricalcitol, and 32% calcium-based phosphate binders, although these drugs were not linked with pre- or post-dialysis Ca levels in or dialysate treatment. CONCLUSION: We concluded that the prescription of Ca dialysate needs to be individualised based on pre- and post-dialysis Ca values and the need for an increase, decrease, or no changes in post-dialysis calcium in relation to the clinical condition of the patient's phosphorous-calcium metabolism.