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Pitfalls of measuring total blood calcium in patients with CKD.

ABSTRACT: Disorders of mineral and bone metabolism are prevalent in patients with chronic kidney disease (CKD). The recent National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines recommend that blood calcium (Ca) be regularly measured in patients with stages 3 to 5 CKD. The Kidney Disease: Improving Global Outcomes (KDIGO) position states that the measurement of ionized Ca (iCa) is preferred and that if total Ca (tCa) concentration is used instead, then it should be adjusted in the setting of hypoalbuminemia. In 691 consecutive patients with stages 3 to 5 CKD, we compared the ability of noncorrected and albumin-corrected tCa concentration to identify low, normal, or high iCa concentration. The agreement between noncorrected or albumin-corrected tCa and iCa was only fair. The risk for underestimating ionized calcium was independently increased by a low total CO(2) concentration when either noncorrected or albumin-corrected Ca was used and by a low albumin concentration only when noncorrected tCa was used. The risk for overestimating iCa was increased by a low albumin concentration only when albumin-corrected Ca was used. In conclusion, albumin-corrected tCa does not predict iCa better than noncorrected tCa. Moreover, both noncorrected and albumin-corrected tCa concentrations poorly predict hypo- or hypercalcemia in patients with CKD.

SUBMITTER: Gauci C

PROVIDER: S-EPMC2488254 | biostudies-literature | 2008 Aug

REPOSITORIES: biostudies-literature

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Pitfalls of measuring total blood calcium in patients with CKD.

Gauci Cédric C Moranne Olivier O Fouqueray Bruno B de la Faille Renaud R Maruani Gérard G Haymann Jean-Philippe JP Jacquot Christian C Boffa Jean-Jacques JJ Flamant Martin M Rossert Jérôme J Urena Pablo P Stengel Bénédicte B Souberbielle Jean-Claude JC Froissart Marc M Houillier Pascal P

Journal of the American Society of Nephrology : JASN 20080409 8

Disorders of mineral and bone metabolism are prevalent in patients with chronic kidney disease (CKD). The recent National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines recommend that blood calcium (Ca) be regularly measured in patients with stages 3 to 5 CKD. The Kidney Disease: Improving Global Outcomes (KDIGO) position states that the measurement of ionized Ca (iCa) is preferred and that if total Ca (tCa) concentration is used instead, then it should be adjus ...[more]

PMID: 18400941

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Project description:OBJECTIVES:Although many secondary effects of high levels of vanadium (V) and chromium (Cr) overlap with symptoms seen in paediatric patients with chronic kidney disease (CKD), their plasma V and Cr levels are understudied. DESIGN:Ancillary cross-sectional study to a prospective, longitudinal, randomised controlled trial. SETTING:Children's Hospital of Western Ontario, London Health Sciences Centre, London, Ontario, Canada. PARTICIPANTS:36 children and adolescents 4-18 years of age with CKD. INTERVENTIONS:1-6 trace element measurements per patient. Cystatin C (CysC) estimated glomerular filtration rate (eGFR) was calculated using the Filler formula. Plasma V and Cr levels were measured using high-resolution sector field inductively coupled mass spectrometry. Anthropomorphic data and blood parameters were collected from our electronic chart programme. Water Cr and V data were obtained from the Ontario Water (Stream) Quality Monitoring Network. PRIMARY AND SECONDARY OUTCOME MEASURES:Primary outcomes: plasma Cr and V. SECONDARY OUTCOMES:age, season, CysC, CysC eGFR, and Cr and V levels in environmental water. RESULTS:The median (IQR) eGFR was 51?mL/min/1.73?m2 (35, 75). The median V level was 0.12?µg/L (0.09, 0.18), which was significantly greater than the 97.5th percentile of the reference interval of 0.088?µg/L; 32 patients had at least one set of V levels above the published reference interval. The median Cr level was 0.43?µg/L (0.36, 0.54), which was also significantly greater than the established reference interval; 34 had at least one set of Cr levels above the published reference interval. V and Cr levels were moderately correlated. Only some patients had high environmental exposure. CONCLUSIONS:Our study suggests that paediatric patients with CKD have elevated plasma levels of V and Cr. This may be the result of both environmental exposure and a low eGFR. It may be necessary to monitor V and Cr levels in patients with an eGFR <30?mL/min/1.73?m2. TRIAL REGISTRATION NUMBER:NCT02126293; HC#172241.

Project description:Rationale & objectivePatients with CKD are at elevated risk of metabolic acidosis due to impaired net acid excretion (NAE). Identifying early markers of acidosis may guide prevention in chronic kidney disease (CKD). This study compared NAE in participants with and without CKD, as well as the NAE, blood pressure (BP), and metabolomic response to bicarbonate supplementation.Study designRandomized order, cross-over study with controlled feeding.Setting & participantsParticipants consisted of 8 patients with CKD (estimated glomerular filtration rate 30-59mL/min/1.73m2 or 60-70mL/min/1.73m2 with albuminuria) and 6 patients without CKD. All participants had baseline serum bicarbonate concentrations between 20 and 28 mEq/L; they did not have diabetes mellitus and did not use alkali supplements at baseline.InterventionParticipants were fed a fixed-acid-load diet with bicarbonate supplementation (7 days) and with sodium chloride control (7 days) in a randomized order, cross-over fashion.OutcomesUrine NAE, 24-hour ambulatory BP, and 24-hour urine and plasma metabolomic profiles were measured after each period.ResultsDuring the control period, mean NAE was 28.3±10.2 mEq/d overall without differences across groups (P=0.5). Urine pH, ammonium, and citrate were significantly lower in CKD than in non-CKD (P<0.05 for each). Bicarbonate supplementation reduced NAE and urine ammonium in the CKD group, increased urine pH in both groups (but more in patients with CKD than in those without), and increased; urine citrate in the CKD group (P< 0.2 for interaction for each). Metabolomic analysis revealed several urine organic anions were increased with bicarbonate in CKD, including 3-indoleacetate, citrate/isocitrate, and glutarate. BP was not significantly changed.LimitationsSmall sample size and short feeding duration.ConclusionsCompared to patients without CKD, those with CKD had lower acid excretion in the form of ammonium but also lower base excretion such as citrate and other organic anions, a potential compensation to preserve acid-base homeostasis. In CKD, acid excretion decreased further, but base excretion (eg, citrate) increased in response to alkali. Urine citrate should be evaluated as an early and responsive marker of impaired acid-base homeostasis.FundingNational Institute of Diabetes and Digestive and Kidney Diseases and the Duke O'Brien Center for Kidney Research.Trial registrationRegistered at ClinicalTrials.gov with study number NCT02427594.

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Pitfalls of measuring total blood calcium in patients with CKD.

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Pitfalls of measuring total blood calcium in patients with CKD.

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