Background. It is ionized calcium that is physiologically active and under
homeostatic control; however, total calcium is more conveniently measured.
Formulae for correction of calcium to account for albumin binding have not
been validated in a dialysis setting.
Methods. We measured ionized calcium simultaneously with total calcium (t[C
a]), albumin, total protein and pH before dialysis in 50 stable outpatients
and convalescent inpatients.
Results. Although 92% of patients were taking calcium supplements and 70% t
aking alphacalcidol, 11 patients (22%) had ionized hypocalcaemia. To facili
tate comparison of calculated ionized calcium, measured total calcium (t[Ca
]), and 'corrected' calcium (c[Ca]), with the criterion measure of ionized
calcium, all measurements were converted to z scores, standardized on the n
ormal range for each variable. Results are expressed as intraclass correlat
ion coefficients (ICC: 0, all differences are due to error; 1, all differen
ces are due to between patient variation).
Conclusions. None of the published formulae greatly improved the test chara
cteristics beyond simply using the total calcium. A correction formula in w
idespread use (Payne), quoted in reference texts, agreed less well with ion
ized calcium than did the unadjusted measured calcium. Correction formulae
should be abandoned in favour of the use of uncorrected calcium. In cases o
f doubt, ionized calcium should be directly measured.