Impact of calcium overload on bone and mineral metabolism at 55 hemodialysis centers in Lima

Abstract

BackgroundMineral and bone metabolism disorders are common complications in hemodialysis patients that present significant geographical variability. ObjectivesThe objective of this study was to assess these disorders for the first time in hemodialysis patients from Peru. MethodsThe study included 1551 hemodialysis patients from 55 centers affiliated with the Social Health System of Peru in the city of Lima. Demographic data, comorbidities, treatments and biochemical parameters were collected from each patient. Serum calcium, phosphorus and PTH levels were categorized according to the recommended ranges in the KDOQI and KDIGO guidelines. ResultsThe mean age of the patients was 59.5±15.6 years, with a mean time on hemodialysis of 58.0±54.2 months. All patients were dialyzed with a calcium concentration in the dialysis fluid of 3.5mEq/l and 68.9% of patients were prescribed phosphate-binding agents (98.4% of them calcium carbonate). A high percentage of patients showed serum calcium above, and serum phosphorus below, the recommended ranges in the KDOQI guidelines (32.8% and 37.3%, respectively). More than half of the patients had serum PTH values below the recommended ranges of both the KDOQI and KDIGO guidelines (56.4% and 51.6%, respectively). ConclusionsPatients included in this study were younger than those from other studies and showed both hypophosphataemia and suppressed PTH, probably due to an excessive calcium overload through dialysis fluid and the use of calcium-containing phosphate binding agents.