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Dialysate Calcium Adjustment — ESENeph MCQ

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ModerateHaemodialysisDialysate Calcium AdjustmentESENeph

A 60-year-old man with CKD G5D on HD has a calcium of 2.0 mmol/L, phosphate 2.4 mmol/L, and PTH 110 pmol/L. His dialysate calcium is 1.25 mmol/L. He has persistent hypocalcaemia. Should the dialysate calcium be increased?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Increasing dialysate calcium to 1.50 or 1.75 mmol/L can help correct persistent hypocalcaemia – higher dialysate calcium provides a positive calcium balance during dialysis; however this must be balanced against risk of vascular calcification

Dialysate calcium concentration directly influences calcium balance during HD. Standard dialysate calcium is 1.25 mmol/L (neutral to slightly negative balance). Higher concentrations (1.50-1.75 mmol/L) provide positive calcium influx during dialysis, helping correct persistent hypocalcaemia. However, KDIGO 2017 CKD-MBD cautions that higher dialysate calcium may promote vascular calcification and suppress PTH excessively. The choice must be individualised: higher dialysate calcium is appropriate for patients with persistent symptomatic hypocalcaemia, post-parathyroidectomy, or those on calcimimetics causing low calcium.

Reference: KDIGO 2017 – CKD-MBD; ERA-EDTA 2019 – Dialysate Prescription