Abstract
The influence of the pH of the blood and the dialysate calcium concentration on post-dialysis serum-calcium levels was investigated by equilibrium dialysis in vitro. Total serum-calcium was directly related to variations in the blood pH. The increase in total serum-calcium observed after dialysis is due primarily to the increase in protein-bound calcium, brought about by correction of acidosis by dialysis. Within the conditions of this study, in which the pH was corrected to between 7·36 and 7·56, the average difference between the dialysate and the post-dialysis serum-calcium levels may be expressed by the ratio 1/1·75. The increase in serum-diffusible-calcium caused by a high dialysate calcium, or by dissociation of protein-bound calcium into the ionised form during recurrent acidosis between dialyses, must contribute to the deposition of calcium phosphate in the soft tissues of patients receiving repeated dialysis. A nomogram has been constructed from which the post-dialysis calcium level in the patient, whose pH has been corrected by dialysis, can be predicted for varying levels of calcium in the dialysate fluid.
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