DOI QR코드

DOI QR Code

Whole blood versus serum ionized calcium concentrations in dialysis patients

  • Kang, Seok Hui (Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center) ;
  • Cho, Kyu Hyang (Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center) ;
  • Park, Jong Won (Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center) ;
  • Yoon, Kyung Woo (Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center) ;
  • Do, Jun Young (Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center)
  • 투고 : 2012.09.13
  • 심사 : 2012.12.07
  • 발행 : 2014.03.01

초록

Background/Aims: The aim of this study is to measure the difference of ionized calcium between heparinized whole blood and serum. Methods: We recruited 107 maintenance hemodialysis (HD) patients from our hospital HD unit. The clinical and laboratory data included ionized calcium in serum and in whole blood (reference, 4.07 to 5.17 mg/dL). Results: The level of ionized calcium in serum was higher than that in whole blood (p < 0.001). Bland-Altman analysis showed that difference for ionized calcium was 0.5027. For the difference, the nonstandardized $\beta$ was -0.4389 (p < 0.001) and the intercept was 2.2418 (p < 0.001). There was a significant difference in the distribution of categories of ionized calcium level between two methods ($\kappa$, 0.279; p < 0.001). Conclusions: This study demonstrates that whole blood ionized calcium is underestimated compared with serum ionized calcium. Positive difference increases as whole blood ionized calcium decreases. Therefore, significant hypocalcemia in whole blood ionized calcium should be verified by serum ionized calcium.

키워드

참고문헌

  1. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(4 Suppl 3):S1-S201.
  2. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004;15:2208-2218. https://doi.org/10.1097/01.ASN.0000133041.27682.A2
  3. Young EW, Albert JM, Satayathum S, et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2005;67:1179-1187. https://doi.org/10.1111/j.1523-1755.2005.00185.x
  4. An WS, Kim SE, Kim KH, Bae HR, Rha SH. Associations between oxidized LDL to LDL ratio, HDL and vascular calcification in the feet of hemodialysis patients. J Korean Med Sci 2009;24 Suppl:S115-S120. https://doi.org/10.3346/jkms.2009.24.S1.S115
  5. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009;(113):S1-S130.
  6. Gauci C, Moranne O, Fouqueray B, et al. Pitfalls of measuring total blood calcium in patients with CKD. J Am Soc Nephrol 2008;19:1592-1598. https://doi.org/10.1681/ASN.2007040449
  7. Sachs C, Rabouine P, Chaneac M, Kindermans C, Dechaux M. In vitro evaluation of a heparinized blood sampler for ionized calcium measurement. Ann Clin Biochem 1991;28(Pt 3):240-244. https://doi.org/10.1177/000456329102800307
  8. D'Orazio P, Toffaletti JG, Wandrup J; National Committee for Clinical Laboratory Standards. Ionized Calcium Determinations: Precollection Variables, Specimen Choice, Collection, and Handling: Approved Guideline. 2nd ed. Wayne: National Committee for Clinical Laboratory Standards, 2001.
  9. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-310.
  10. Bland JM, Altman DG. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet 1995;346:1085-1087. https://doi.org/10.1016/S0140-6736(95)91748-9
  11. McLean FC, Hastings BA. The state of calcium in the fluids of the body: I. the conditions affecting the ionization of calcium. J Biol Chem 1935;108:285-321.
  12. Hinkle JE, Cooperman LH. Serum ionized calcium changes following citrated blood transfusion in anaesthetized man. Br J Anaesth 1971;43:1108-1112. https://doi.org/10.1093/bja/43.12.1108
  13. Thode J, Fogh-Andersen N, Wimberley PD, Moller Sorensen A, Siggaard-Andersen O. Relation between pH and ionized calcium in vitro and in vivo in man. Scand J Clin Lab Invest Suppl 1983;165:79-82.

피인용 문헌

  1. Usefulness and feasibility of measuring ionized calcium in haemodialysis patients vol.8, pp.4, 2014, https://doi.org/10.1093/ckj/sfv039
  2. A novel alendronate functionalized nanoprobe for simple colorimetric detection of cancer-associated hypercalcemia vol.10, pp.28, 2014, https://doi.org/10.1039/c8nr02570c
  3. Time-dependent variation of ionized calcium in serum samples vol.29, pp.3, 2019, https://doi.org/10.11613/bm.2019.030708
  4. CaCO3 nanoparticles pH-sensitively induce blood coagulation as a potential strategy for starving tumor therapy vol.8, pp.6, 2020, https://doi.org/10.1039/c9tb02684c
  5. The target range for ionized calcium levels in dialysis patients―Ionized calcium values differ between outsourced serum tests and in-hospital whole blood gas analysis― vol.53, pp.9, 2014, https://doi.org/10.4009/jsdt.53.471
  6. Hypocalcaemia and calcium intake in pregnancy: A research protocol for critical analysis of risk factors, maternofoetal outcomes and evaluation of diagnostic methods in a third-category health facilit vol.15, pp.11, 2014, https://doi.org/10.1371/journal.pone.0241812