Does low-calcium dialysate accelerate secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis patients?

A lower-calcium dialysate has been advocated for continuous ambulatory peritoneal dialysis (CAPD) patients for the purpose of increasing oral calcium intake as a phosphate binder and decreasing the need for aluminum-containing phosphate binders and, hence, decreasing the risk of aluminum intoxication. Twelve CAPD patients were evaluated retrospectively after switching from a dialysate containing 3.5 mEq/L of calcium to a new dialysate containing 2.5 mEq/L of calcium. Patients were on the new dialysate for at least 1 year. Serum calcium, phosphate, alkaline phosphatase, aluminum, and intact or N-terminal parathyroid hormone (I-PTH, N-PTH) were measured. Calcium, phosphate, and aluminum did not change significantly. Alkaline phosphatase doubled, but was not statistically significant. I-PTH and N-PTH rose from 2.9 +/- 2.24 to 7.4 +/- 7.4 times normal (p < 0.012). Three of 7 patients who had x-ray evaluations before, during, and 1 year after change of dialysate had radiographic progression of bone disease. Three patients required a parathyroidectomy due to the development of severe secondary hyperparathyroidism. In conclusion, the indiscriminate use of dialysate containing 2.5 mEq/L of calcium, in CAPD patients, may place the patients at higher risk for progression of hyperparathyroidism.

Low-dose subcutaneous erythropoietin in continuous ambulatory peritoneal dialysis.

We evaluated changes in hematocrit in patients on continuous ambulatory peritoneal dialysis (CAPD) before and after the administration of erythropoietin (EPO). Thirty-five patients were evaluated at the beginning of treatment with CAPD and after an average of 3.5 years on CAPD; mean hematocrit (Hct) rose from 25.4 +/- 5.4% to 28.1 +/- 6.7% (P less than 0.001). In the period before EPO administration 11 patients required a total of 44 transfusions (one patient needed 23 transfusions). Fifteen patients were started on subcutaneous erythropoietin 3,000 units 3 times a week and were followed for a mean period of 6.3 months. Hct rose from 23.8 +/- 1.8% to 25.2 +/- 2.4% (P less than 0.01) within the first 2 weeks and up to 27.5 +/- 3.7% (P less than 0.01) in the fourth week. By the eighth week the target Hct (30 to 35%) was reached. During the next 5 months the EPO doses were adjusted to each patient's needs ranging between 2,000 U per week to 4,000 U 3 times per week. Mild hypertension was the only side effect seen in some of the patients. In conclusion low dose subcutaneous EPO is effective in managing the anemia of patients on CAPD with only minor side effects.

Ten years' experience with continuous ambulatory peritoneal dialysis.

Up to January 1989, 171 patients were trained at our center on continuous ambulatory peritoneal dialysis (CAPD), and 17 on continuous cyclic peritoneal dialysis (CCPD). Over 10 years, we have gained 5,068 patient-months experience. Patient survival was 60% and 31% at 5 and 10 years, respectively. In contrast, diabetics had a survival of 32% at 5 years. Major complications included 499 new episodes of peritonitis, 304 exit-site infections, 22 hernias, five bowel perforations, one hydrothorax, and three episodes of sclerosing encapsulating peritonitis. Our technique survival has been 62% and 40% at 5 and 10 years, respectively. We believe that CAPD is a viable dialysis technique for long-term treatment of chronic renal failure and it should be offered as an option to intermittent hemodialysis.