In patients on peritoneal dialysis (PD), 1.75 vs 1.25 mmol/L dialysate calcium is more effective at treating secondary hyperparathyroidism (SHPT), but the 1.25 mmol/L dose is better at easing secondary hypercalcemia, according to Liqin Jin, MD, of Beijing Luhe Hospital Capital Medical University in China, and colleagues.

In their meta-analysis of 4 randomized controlled trials (RCTs) and 3 non-RCTs comparing 1.25 mmol/L to 1.75 mmol/L dialysate calcium for PD, the 1.75 mmol/L dose reduced intact parathyroid hormone levels significantly more. However, the 1.25 mmol/L dose better reduced total and ionized calcium, according to results published in BMC Nephrology.

The investigators found no significant differences in serum phosphate levels and peritonitis episodes between the groups, but the study sample was small.  

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Dr Jin and the team acknowledged that a subset of patients have SHPT and hypercalcemia concurrently: “Further well-designed and high-quality studies are required to determine suitable dialysate calcium concentration for patients with both hyperparathyroidism and hypercalcemia.”

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Jin L, Zhou J, Shao F, Yang F. Long-term effects on PTH and mineral metabolism of 1.25 versus 1.75 mmol/L dialysate calcium in peritoneal dialysis patients: a meta-analysis. BMC Nephrol. 20:213. doi:10.1186/s12882-019-1388-9