Abstract
Studies in adults show superior serum phosphate and parathyroid hormone (PTH) control on slow nocturnal haemodialysis (NHD) compared with conventional haemodialysis. We studied the progress of four children aged 12, 13, 14 and 16 years after they had been initiated on NHD. The follow-up period ranged from 6 months to 20 months. Biochemical indices of bone metabolism were collected prospectively. All four children were initially dialysed against a 1.5 mmol/l calcium bath. In two patients, owing to biochemical hypocalcaemic episodes, the dialysate calcium concentration was increased to 1.75 mmol/l. One patient became hypercalcaemic and received calcitonin for bone pain secondary to osteoporosis and was dialysed against a 1.0 mmol/l calcium bath. Including an evaluation of dietary intake, all four patients had a net positive calcium balance, ranging from 5.1 mmol/m2 body surface area (BSA) per day to 24.3 mmol/m2 BSA per day. A significant reduction in the pre-dialysis phosphate level was observed in all four patients, such that none required dietary restrictions or phosphate binders, and dialysate phosphate supplements of 0.8–2.03 mmol/l were employed to prevent hypophosphataemia. The (Ca×PO4) dropped below 4.4 mmol2 l−2 in all four patients. Concurrently, significant reductions in intact PTH levels were seen in all four patients, but the level dropped to below normal range in two. In our cohort of patients, NHD rapidly lowered plasma phosphate and PTH levels, and additional dialysate phosphate and possibly calcium may be necessary to prevent bone demineralisation due to chronic losses and to prevent oversuppression of PTH.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Mathias R, Salusky IB, Harman WH, Paredes A, Emans J, Segre G, Goodman W (1993) Renal bone disease in pediatric patients and young adults treated by hemodialysis in a children’s hospital. J Am Soc Nephrol 12:1938–1946
Spalding EM, Chamney PW, Farrington K (2002) Phosphate kinetics during haemodialysis: evidence for biphasic regulation. Kidney Int 61:655–667
Fajardo L, Campistrús, Ríos P, Góomez T (2003) Evolution of serum phosphate in long intermittent haemodialysis. Kidney Int 63 [Suppl 85]:S66–S68
Lindsay RM, Alhejaili F, Nesrallah G, Leitch R, Clement L, Heidenheim AP, Kortas C (2003) Calcium and phosphate balance with quotidian hemodialysis. Am J Kidney Dis 42:24–29
Al-Hejaili F, Kortas C, Leitch R, Heidenheim PA, Clement L, Nesrallah G, Lindsay RM (2003) Nocturnal but not short hours quotidian hemodialysis requires an elevated dialysate calcium concentration. J Am Soc Nephrol 14:2322–2328
Pierratos A (2004) Daily nocturnal hemodialysis. Kidney Int 65:1975–1986
Geary DF, Piva E, Gajaria M, Tyrrel J, Picone G, Harvey E (2004) Development of a nocturnal home hemodialysis (NHHD) program for children. Semin Dial 17:115–117
Simonsen O (2000) Slow nocturnal dialysis as a rescue treatment for children and young patients with end-stage renal failure. J Am Soc Nephrol 11:327A
Geary DF, Piva E, Tyrrel J, Gajaria MJ, Picone G, Keating LE, Harvey EA (2005) Home nocturnal hemodialysis in children. J Pediatr 147:383–387
Fischbach M, Edefonti A, Schröder C, Watson A, The European Pediatric Dialysis Working Group (2005) Hemodialysis in children: general practical guidelines. Pediatr Nephrol 20:1054–1066
Fischbach M, Boudailliez B, Foulard M (1997) Phosphate end dialysis value: a misleading parameter of hemodialysis efficiency. Pediatr Nephrol 11:193–195
Pogglitsch H, Estelberger W, Petek W, Zitta S, Ziak E (1989) Relationship between generation and plasma concentration of inorganic phosphorous. In vivo studies in dialysis patients and in vitro studies on erythrocytes. Int J Artif Organs 12:524–532
Fischbach M, Hamel G, Simeoni U, Geisert J (1992) Phosphate dialytic removal: enhancement of phosphate cellular clearance by biofiltration (with acetate-free buffer dialysate). Nephron 62:155–160
Bose S, French S, Evans FJ, Joubert F, Balaban RS (2003) Metabolic network control of oxidative phosphorylation: multiple roles of inorganic phosphate. J Biol Chem 278:39155–39165
Lotz M, Zisman E, Bartter FC (1968) Evidence for phosphorus depletion syndrome in man. N Eng J Med 278:409–415
Anderson PT, Toft E, Hansen AK, Sinkjaer T (1991) Postoperative hypophosphataemia and muscle function. Br J Surg 78:114–116
Hinken AC, McDonald KS (2004) Inorganic phosphate speeds loaded shortening in rat skinned cardiac myocytes. Am J Physiol Cell Physiol 287:C500–C507
Salusky IB, Kuizon BG, Jüppner H (2004) Special aspects of renal osteodystrophy in children. Semin Nephrol 24:69–77
Solal ME, Sebert JL, Boudailliez B, Marie A, Moriniere P, Gueris J, Bouillan R, Fournier A (1991) Comparison of intact, midregion, and carboxy-terminal assays of parathyroid hormone for the diagnosis of bone disease in hemodialyzed patients. J Clin Endocrinol Metab 73:516–524
Qi Q, Monier-Faugere MC, Geng Z, Malluche HH (1995) Predictive value of serum parathyroid hormone levels for bone turnover in patients on chronic maintenance dialysis. Am J Kidney Dis 26:622–631
Waller S, Ridout D, Cantor T, Rees L (2005) Differences between “intact” PTH and 1–84 PTH assays in chronic renal failure and dialysis. Pediatr Nephrol 20:197–199
Clinical practice guidelines for bone metabolism and disease in chronic kidney disease (2002) Guideline 1. Evaluation of calcium and phosphorous metabolism. NKF K/DOQI guidelines
Kurz P, Monier-Faugere MC, Bognar B, Werner E, Roth P, Vlachojannis J, Malluche HH (1994) Evidence of abnormal calcium homeostasis in patients with adynamic bone disease. Kidney Int 46:855–861
Moe SM, Chen NX (2003) Calciphylaxis and vascular calcification: a continuum of extra-skeletal osteogenesis. Pediatr Nephrol 18:969–975
Kuizon BD, Salusky IB (2002) Cell biology of renal osteodystrophy. Pediatr Nephrol 17:777–789
Amann K, Ritz E, Wiest G, Klaus G, Mall G (1994) A role of parathyroid hormone for the activation of cardiac fibroblasts in uremia. J Am Soc Nephrol 4:1814–1819
Querfeld U (2004) The clinical significance of vascular calcification in young patients with end-stage renal disease. Pediatr Nephrol 19:478–484
Spasovski GB, Bervoets AR, Behets GJ, Ivanovski N, Sikole A, Dams G, Couttenye MM, De Broe ME, D’Haese PC (2003) Spectrum of renal bone disease in end-stage renal failure patients not yet on dialysis. Nephrol Dial Transplant 18:1159–1166
Langman CB, Mazur AT, Baron R, Norman ME (1982) 25-Hydroxyvitamin D3 (calcifediol) therapy of juvenile renal osteodystrophy: beneficial effect on linear growth velocity. J Pediatr 100:815–882
Song Y, Kato S, Fleet JC (2003) Vitamin D receptor (VDR) knockout mice reveal VDR-independent regulation of intestinal calcium absorption and ECaC2 and calbindin D9k mRNA. J Nutr 133:374–380
Salusky IB, Kuizon BD, Belin TR, Ramirez JA, Gales B, Segre GV, Goodman WG (1998) Intermittent calcitriol therapy in secondary hyperparathyroidism: a comparison between oral and intraperitoneal administration. Kidney Int 54:907–914
Logue FC, Fraser WD, O’Reilly DS, Cameron DA, Kelly AJ, Beastall GH (1990) The circadian rhythm of intact parathyroid hormone- (1–84): temporal correlation with prolactin secretion in normal men. J Clin Endocrinol Metab 71:1556–1560
Fraser WD, Logue FC, Christie JP, Gallacher SJ, Cameron D, O’Reilly DS, Beastall GH, Boyle IT (1998) Alteration of the circadian rhythm of intact parathyroid hormone and serum phosphate in women with established postmenopausal osteoporosis. Osteoporos Int 8:121–126
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hothi, D.K., Harvey, E., Piva, E. et al. Calcium and phosphate balance in adolescents on home nocturnal haemodialysis. Pediatr Nephrol 21, 835–841 (2006). https://doi.org/10.1007/s00467-006-0048-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-006-0048-z