Metabolism of the phosphate and calcium balance in chronic kidney disease: Focus in peritoneal dialysis
DOI:
https://doi.org/10.25796/bdd.v7i3.83573Keywords:
peritoneal dialysis, phosphocalcium metabolism, low-calcium glucose dialysateAbstract
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Patients with chronic kidney disease (CKD) have abnormal phosphocalcic metabolism. Biologically, this translates into hypocalcemia, hyperphosphatemia, secondary or even tertiary hyperparathyroidism, and increased total and bone alkaline phosphatases. The clinical consequences are an increase in morbidity and mortality, with cardiovascular disease in particular, and bone complications secondary to abnormalities in bone remodeling, with a consequent risk of fracture. Only 25% to 50% of peritoneal dialysis (PD) patients have a phosphocalcium balance within the recommended targets. It is essential to correct this. Particular attention must be paid to the choice of calcium concentration in glucose solutions, taking into account the clinical context and favoring low-calcium solutions (concentration at 1.25 mmol/L). Diet and dietary monitoring are recommended as first-line treatment, with calcium-free phosphate binders if necessary. The aim is to avoid hypercalcemia and hyperphosphatemia. Finally, phosphate extraction is more important in continuous ambulatory PD (CAPD) than in automated PD (APD).
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