Effects of Lowering Dialysate Calcium Concentrations on Arterial Stiffness in Patients Undergoing Hemodialysis

Kim, Jwa-Kyung; Moon, Sung Jin; Park, Hyeong Cheon; Lee, Jae Sung; Sim, Soung Rok; Bae, Sung Chang; Ha, Sung Kyu

doi:10.3904/kjim.2011.26.3.320

Cited by 16 publications

(20 citation statements)

References 27 publications

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“…In our study, we found that low calcium dialysate (1.25 mmol/L) treatment is associated with the decreased serum fetuin A in PD patients. Our result for fetuin A was not consistent with that in Kim et al 19 However, the characteristics of these two studies were different (patients' types: PD patients vs. hemodialysis patients; low calcium dialysate: 1.25 mmol/L vs. 1.50 mmol/L). In different dialysis patients, whether the association of the calcium concentrations with fetuin A level was different, it was not clear.…”

Section: Discussioncontrasting

confidence: 57%

“…15,17,18 There was no report on the association of dialysate calcium concentration with fetuin A level in PD patients. However, Kim et al 19 performed a prospective study, and 20 patients on maintenance hemodialysis with dialysate calcium concentrations of 1.75 mmol/L were enrolled, and the dialysate calcium level was lowered to 1.50 mmol/L at the start of the study. They found that lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which might have been associated with upregulation of serum fetuin A.…”

Section: Discussionmentioning

confidence: 99%

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Association of dialysate calcium concentration with fetuin a level and carotid intima-media thickness in peritoneal dialysis patients

Wang

Liu

et al. 2013

Renal Failure

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Guangzhou, ChinaAbstract Serum fetuin A has been shown to be associated with the risk of vascular calcification and atherosclerosis, and it can predict the onset of cardiovascular mortality in dialysis patients. The carotid intima-media thickness (cIMT) is an accessible and reliable method to identify the subclinical atherosclerosis. The aim of this study was to investigate the relationships between dialysate calcium concentrations and fetuin A or cIMT in patients undergoing peritoneal dialysis (PD). Forty patients, newly diagnosed end-stage renal disease (ESRD) and undergoing peritoneal dialysis, were enrolled in the study, with a calcium content of the peritoneal dialysis (PD) solution of 1.25 mmol/L in 20 patients (low-Ca group) and 1.75 mmol/L in 20 patients (standard-Ca group). The patients were followed up for 12 months after the PD conducted. Serum fetuin A was determined using a human fetuin A enzyme-linked immunosorbent assay kit and cIMT was detected using ultrasonic wave. We observed no difference between two groups with regard to the baseline data of fetuin A, cIMT, calcium, phosphorus, calcium-phosphorus product, high sensitivity CRP (hsCRP), parathyroid hormone (PTH), or lipid parameters. After 12 months follow-up, fetuin A (263.92 AE 16.1 vs. 282.76 AE 21.0, p ¼ 0.017) and calcium-phosphorus product (39.85 AE 7.76 vs. 47.50 AE 6.65, p ¼ 0.009) were obviously lower in the low-Ca group than standard-Ca group, the other serum parameters were not different between these two groups. Compared with baseline data, serum fetuin A concentration significantly reduced in low-Ca group ( p50.05). The number of patients with increased cIMT and newly occurring cardiovascular events in the low-Ca group were significantly reduced than standard-Ca group ( p50.05). In conclusion, our data suggest that low calcium dialysate treatment is associated with the decreased serum fetuin A concentration and serum calcium-phosphorus product, and it is associated with the reduced number of PD patients with increased cIMT or with newly occurring cardiovascular events. However, more studies with lager sample size should be performed in the future.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Association of dialysate calcium concentration with fetuin a level and carotid intima-media thickness in peritoneal dialysis patients

Wang

Liu

et al. 2013

Renal Failure

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“…Their results showed that low calcium dialysate significantly improved the arterial stiffness parameters. 11 As it has been proved that aortic stiffness led to LV hypertrophy. 13 Researchers assigned 30 patients on HD to be treated with dialysate calcium concentration of 1.12 or 1.37 mmol/L for 6 months.…”

Section: Discussionmentioning

confidence: 99%

The influence of low calcium dialysate on left ventricular diastolic function in peritoneal dialysis patients

Wang

Wen

et al. 2016

Renal Failure

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Left ventricular (LV) diastolic function was found to be a significant predictor of cardiovascular events and general mortality in dialysis. Studies have indicated that dialysate calcium concentrations were significantly associated with cardiac function. However, the relationship between low calcium dialysate and LV diastolic function has not been clear. The aim of this study was to investigate the influence of low calcium dialysate on cardiac function in peritoneal dialysis (PD) patients. A total of 60 PD patients were enrolled in this study, with a calcium content of the PD solution of 1.25 mmol/L in 30 patients (low-calcium group) and 1.75 mmol/L in 30 patients (standard-calcium group). Standard M-mode and two-dimensional ultrasound measurements were applied to detect the cardiac function. After 12-month follow-up, we found no significant difference in blood pressure, calcium, phosphorus, parathyroid hormone (PTH), etc., between the two groups. Residual renal function (RRF), which is associated with LV cardiac function, was significantly decreased in the standard-calcium group compared with the low-calcium group (5.64 ± 3.23 vs. 9.38 ± 3.17, p ¼ .001). Compared with the low-calcium group, E max (peak early diastolic velocity) and A max (peak late diastolic velocity) were significantly decreased (p < .05), whereas myocardial performance index (MPI) was obviously increased in standard-calcium group (9.69 ± 2.71 vs. 7.75 ± 0.93, p < .05). In conclusion, our data suggest that low calcium dialysate treatment is significantly associated with better LV diastolic function. ARTICLE HISTORY

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“…Imbalances between factors that promote and factors that inhibit calcification interact with a positive balance or high concentrations of calcium and phosphate to promote vascular calcification [22,23,24]. Dialysis with high dialysate [calcium] has been associated to progression of arterial stiffness [25] while dialysis with 2.5 mEq/l dialysate calcium for 6 months decreased arterial stiffness [26]. Thus, it seems reasonable to avoid a calcium overload from dialysate in hemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Individualization of Dialysate Calcium Concentration According to Baseline Pre-Dialysis Serum Calcium

et al. 2014

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Background: A positive calcium balance may contribute to vascular calcification, while a negative balance increases iPTH. We explored the impact of different dialysate calcium concentrations on bone and mineral metabolism parameters according to pre-dialysis serum calcium levels. Results: Fifty-six hemodialysis patients were dialyzed with 3.0 or 2.5 mEq/l dialysate [calcium] in a crossover study of two weeks. Bone mineral metabolites were measured prior to and following the hemodialysis session. A 3.0 mEq/l dialysate [calcium] increased more post-dialysis total calcium and ionized calcium than 2.5 mEq/l dialysate [calcium]. The mildest dialysis-induced changes in calcium and PTH were observed in patients with pre-dialysis serum calcium <8.75 mg/dl dialyzed with 2.5 mEq/l dialysate [calcium] and in patients with pre-dialysis serum calcium >9.15 mg/dl dialyzed with 3.0 mEq/l calcium dialysate. Conclusion: In conclusion, the individualization of dialysate calcium concentration according to baseline pre-dialysis serum calcium may prevent major excursions in post-dialysis serum calcium and iPTH levels. Short Summary: High calcium dialysate may increase serum calcium in hemodialysis patients, while low dialysate calcium may increase PTH. Individualization of dialysate calcium according to predialysis serum calcium levels may prevent or decrease unwanted excursions of both serum calcium and PTH.

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Effects of Lowering Dialysate Calcium Concentrations on Arterial Stiffness in Patients Undergoing Hemodialysis

Cited by 16 publications

References 27 publications

Association of dialysate calcium concentration with fetuin a level and carotid intima-media thickness in peritoneal dialysis patients

Association of dialysate calcium concentration with fetuin a level and carotid intima-media thickness in peritoneal dialysis patients

The influence of low calcium dialysate on left ventricular diastolic function in peritoneal dialysis patients

Individualization of Dialysate Calcium Concentration According to Baseline Pre-Dialysis Serum Calcium

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