Abstract
Disturbed calcium metabolism and mineral bone disease (CKD-MBD) is a common development as patients approach end-stage kidney disease. Clinical laboratories measure total calcium and adjust for serum albumin concentrations to approximate ionised levels and help classify calcium status. The strength of relationship between corrected and ionised calcium weakens below serum albumin levels of 30g/L. Clinical treatment guidelines for CKD-MBD continue to recommend the use of albumin-adjusted calcium for monitoring despite ionised calcium being the biologically active fraction.
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