Development of hypercalcemia during long-term CHDF in patients on maintenance hemodialysis

Abstract

In our hospital, continuous hemodiafiltration (CHDF) is performed in an annual mean of more than 600 patients, and hypercalcemia is sometimes observed during long-term CHDF. We encountered 2 patients on maintenance hemodialysis (HD) who developed hypercalcemia during long-term CHDF after cardiovascular surgery, and evaluated the background of hypercalcemia and preventive measures. Long-term CHDF was performed in HD patients (HD group) and patients not receiving HD (non-HD group), and 2 patients in the HD group developed hypercalcemia during CHDF. Long-term CHDF was defined as CHDF for more than 10 days, while hypercalcemia was defined as corrected Ca levels10.5mg/dL. Using these definitions, changes in the Ca level during long-term CHDF were evaluated in the HD and non-HD groups. As a result, the Ca level elevated with an increase in the treatment days, showing a correlation, in the HD group. In the non-HD group, the Ca level also gradually increased, but the rise was slow compared with that in the HD group, and presented few clinical problems. In the HD group, the cause of hypercalcemia observed in the 2 patients during long-term CHDF could not be identified, but the possible causes included the influences of the Ca load in Sublood^®, total parenteral nutrition solutions, various cytokines associated with multiple organ dysfunction, and disruption of the 1-25D3 metabolic pathway. To prevent these, regular measurement of Ca and consultation with physicians about changes or adjustments of CHDF fluids/dialysates may be important. In the future, careful attention should be paid to the possible development of hypercalcemia during long-term CHDF in HD patients, and blood analysis and appropriate adjustments of fluids and dialysates may be necessary.