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e178 www.ccmjournal.org February 2018 • Volume 46 • Number 2 be well predicted without the need of ionized calcium measurement in most patients. However, the main pitfall is the discontinuous measurement of the ID occurring every 15–30 minutes. During this time, transient drop of the instantaneous clearance can occur because of catheter dysfunction or severe hypotension. Thus, to reduce the risk of severe hypocalcemia related to mistaken measure of the ID and subsequent inadequate calcium reinjection, we recommend maintaining a minimal calcium infusion rate (i.e., 85% of the initial rate) for at least two ID measures. Whether the use of continuous assessment of the instantaneous clearance by spectrophotometric analysis of uremic toxins available in some dialyzer may allow a more accurate calcium reinjection needs to be addressed. The authors have disclosed that they do not have any potential conflicts of interest.