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Adequacy of Calcium and Phosphate Balance in Peritoneal Dialysis

C ontrol of calcium and phosphate balance in peritoneal dialysis (PD) patients is important for two main reasons. First, elevated phosphate levels stimulate secretion of parathyroid hormone (1-3), resulting in hyperparathyroid bone disease. Second, soft tissue and vascular calcification may ensue if the critical calcium x phosphate product is exceeded. Such calcification may playa significant role in the high cardiovascular and cerebrovascular mortality seen in dialysis patients. In addition, hypercalcemia is reported to be associated with the adynamic bone lesion (4), although the significance of this histological finding remains unclear. However, it has become apparent that simply maintaining serum calcium and phosphate within the normal range may not, in itself, be sufficient to avoid these complications. Attention must also be paid to regular monitoring of serum parathyroid hormone (PTH) levels and to whether oral vitamin D3 replacement is required. Sensitive and specific PTH assays are now widely available, enabling the clinician to respond quickly to changes in PTH level. Until recently it has proved very difficult to maintain adequate calcium and phosphate balance in PD patients without resorting to the use of aluminum gels, because the dose of calcium salts required to normalize serum phosphate frequently results in hypercalcemia.