Calcium and phosphorus kinetics in hemodialysis therapy.

The kinetics of interdialytic calcium (Ca) absorption and intradialytic flux are examined with particular emphasis on achievement of near zero Ca mass balance over complete dialysis cycles. It is concluded that a rational approach to management of mineral metabolism in hemodialysis consists of: (1) appropriate doses of vitamin D3 analogs to facilitate now normal Ca absorption and avoid both Ca overload and depletion; (2) adequate phosphorus (P) binder to normalize serum calcium and the Ca P product; (3) in most instances modest reduction of dialysate Ca to the level of 2.00-2.25 are appropriate to assure zero Ca balance, and (4) use of a calcimimetic to control secondary hyperparathyroidism.