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Should Dialysate Calcium be Individualized?


  • Piergiorgio Messa,

    Corresponding author
    1. Nephrology, Dialysis and Renal Transplant Unit, Fondazione Ca' Granda IRCCS, Ospedale Maggiore Policlinico, Milan, Italy
    • Address correspondence to: Piergiorgio Messa, Professor, Nefrologia, Dialisi e Trapianto di rene, via Commenda 15- pad. Croff, 20122 Milano, Italy, Tel.: 0039 0255034551/2, Fax: 0039 0255034550, or e-mail:

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  • Richard A. Sherman

    1. Division of Nephrology, Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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The growing interest in a personalized choice of dialysate calcium concentration faces some important unsolved questions. First, the desired aims to be achieved should be clarified, as different d-Ca concentrations might differentially impact dialysis calcium balance and serum calcium concentration. A second point to be addressed is how to achieve the desired goals; the kinetics of calcium during dialysis treatment are complex. This is not an easy task and probably only an automatic device able to read serum calcium concentration in real-time and adjust d-Ca to it might supply an effective method for individualizing d-Ca. Finally, it is not even clear whether individualizing d-Ca is worth doing; cost-effectiveness studies might give some further insights into this intricate issue.

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