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International Journal of Nephrology
Volume 2011, Article ID 540592, 4 pages
Review Article

Calcium Mass Balances in Bicarbonate Hemodialysis

Nephrology and Dialysis Unit, Miulli General Hospital, 70021 Acquaviva delle Fonti, Italy

Received 28 December 2010; Accepted 24 February 2011

Academic Editor: Angela Wang

Copyright © 2011 Carlo Basile. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Dialysate calcium (Ca) concentration should be viewed as part of the integrated therapeutic regimen to control renal osteodystrophy and maintain normal mineral metabolism. The goals of this integrated approach are to keep the patient in a mild positive Ca mass balance (CaMB), to maintain normal serum Ca levels, to control plasma parathyroid hormone values to two to three times above normal levels, and to avoid soft-tissue calcifications. Thus, a correct net CaMB during hemodialysis (HD) is crucial in the treatment of renal osteodystrophy. Very few studies have been published which measured CaMBs in bicarbonate HD. This is mainly due to the technical difficulties in achieving an accurate measurement of CaMBs owing to the need for the collection of the total spent dialysate or of a proportional aliquot of it. Whereas no doubt exists about the fact that an inlet dialysate Ca concentration (CaD) of 1.75 mmol/L leads to a positive CaMB, more controversial is this issue, when dealing with a CaD of 1.50 mmol/L and, even more, when dealing with a CaD of 1.25 mmol/L. Another important issue is the appropriate CaD in long-hour slow-flow nocturnal HD. Finally, which CaMB should we study: ionized CaMB or total CaMB? This issue is largely discussed in the review.