Effect of Dialysate Calcium Concentration Changes on Plasma Calcium and PTH in Dialysis Patients Treated with Calcium Carbonate as a Phosphate Binder

Even though the efficacy of calcium carbonate(CaCO3)as a phosphate binder has been documented since 1966(1), only recently its use in substitution of Aluminum containing phosphate binders has been recommended in uremic patients in order to avoid the risk of aluminum accumulation and toxicity(2–5).An extensive clinical use of CaCO3 has been limited by frequent occurrence of hypercalcemia(2, 4–6).Thus, the reduction of dialysate calcium concentration(DCa) to 1.5 mmol/1 or less has been suggested to decrease the potential risk of hypercalcemia(3, 4).The aim of our study was to evaluate whether the decrease of DCa from 1.75 to 1.5 mmol/1 was associated with a lower incidence of hypercalcemia and equal control of secondary hyperparathyroidism in hemodialysis patients treated with CaCO3, as a phoshate binder.