The negative Ca 2+ balance is involved in the stimulation of PTH secretion

Keitaro Yokoyama, Shino Kagami, Ichiro Ohkido, Naohiko Kato, Hiroyasu Yamamoto, Takashi Shigematsu, Masaaki Nakayama, Masafumi Fukagawa, Yoshindo Kawaguchi, Tatsuo Hosoya

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


The low calcium (Ca 2+ ) dialysate have been developed to diminish the risk of hypercalcemia with the administration of active vitamin D and Ca 2+ carbonate as phosphate binder. Today, increasing numbers of hemodialysis (HD) patients have been on the low Ca 2+ dialysate (Ca 2+ = 2.5 mEq/l). However, the clinical consequences of a negative calcium net-balance which may be induced by the use of low Ca dialysate are not well evaluated. In the present study, we explored the effects of low Ca 2+ dialysate on the calcium balance and the PTH secretion. Eighty one chronic HD patients (male/female: 47/34; mean age: 60.2 ± 1.5 years; mean HD periods: 11.1 ± 0.8 years) who had been dialyzed with 3.0 mEq/l Ca 2+ dialysate were studied. All patients were transferred to the low Ca dialysate, which actually brought about a negative net-balance in Ca (mean: -94.5 mg) and an increase in serum intact PTH levels (mean: +23.7%: p = 0.03) during a single HD session. However, no changes in serum ionized Ca 2+ were found in spite of negative Ca 2+ balance. One month after change to the low Ca 2+ dialysate (total 12 sessions in each case), serum intact PTH levels increased significantly (186.7 ± 19.5 vs. 216.2 ± 21.9 pg/ml: p = 0.01) in spite of the fact that no changes were found in serum ionized Ca 2+ , Pi and Mg. This result indicates that the negative Ca 2+ balance during low-Ca 2+ hemodialysis-stimulated PTH secretion, which offset the decrease of serum Ca 2+ ; a trade-off phenomenon between negative Ca balance and PTH. This suggests that low Ca 2+ dialysate may exaggerate the progression of secondary hyperparathyroidism.

Original languageEnglish
Pages (from-to)86-90
Number of pages5
Issue number1
Publication statusPublished - 2002 Sep 17


  • Hemodialysis
  • Low calcium dialysate
  • Secondary hyperparathyroidism

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Urology
  • Physiology (medical)


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