High-Flux Hemodialysis and High-Volume Hemodiafiltration Improve Serum Calcification Propensity

Abstract

BackgroundCalciprotein particles (CPPs) may play an important role in the calcification process. The calcification propensity of serum (T50) is highly predictive of all-cause mortality in chronic kidney disease patients. Whether T50 is therapeutically improvable, by high-flux hemodialysis (HD) or hemodiafiltration (HDF), has not been studied yet.MethodsWe designed a cross-sectional single center study, and included stable prevalent in-center dialysis patients on HD or HDF. Patients were divided into two groups based on dialysis modality, were on a thrice-weekly schedule, had a dialysis vintage of > 3 months and vascular access providing a blood flow rate > 300 ml/min. Calcification propensity of serum was measured by the time of transformation from primary to secondary CPP (T50 test), by time-resolved nephelometry.ResultsWe included 64 patients, mean convective volume was 21.7L (SD 3.3L). In the pooled analysis, T50 levels increased in both the HD and HDF group with pre- and post-dialysis (mean (SD)) of 244(64) - 301(57) and 253(55) - 304(61) min respectively (P = 0.43(HD vs. HDF)). The mean increase in T50 was 26.29% for HD and 21.97% for HDF patients (P = 0.61 (HD vs. HDF)). The delta values (Δ) of calcium, phosphate and serum albumin were equal in both groups. Baseline T50 was negatively correlated with phosphate, and positively correlated with serum magnesium and fetuin-A. The ΔT50 was mostly influenced by Δ phosphate (r = -0.342; P = 0.002 HD and r = -0.396; P<0.001 HDF) in both groups.ConclusionsHD and HDF patients present with same baseline T50 calcification propensity values pre-dialysis. Calcification propensity is significantly improved during both HD and HDF sessions without significant differences between both modalities.

The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease

“…Although there was an imbalance between treatment with HD and hemodiafiltration at baseline between the two treatment groups, previous research has shown that there is no difference in T 50 reduction with hemodiafiltration compared with HD (11). Also, there is a risk of false positive findings when performing multiple statistical comparisons, which might have affected the results.…”

“…The mean and SD for predialysis T 50 in patients with ESKD treated with HD have previously been reported to be approximately 250 and 55 minutes, respectively (11). We considered a between-group difference in T 50 of 40 minutes to be clinically relevant.…”

Hemodiafiltration Reduces All-Cause and Cardiovascular Mortality in Incident Hemodialysis Patients: A Propensity-Matched Cohort Study

“…It has been suggested that OL-HDF reduces cardiovascular risk because it improves hemodynamic stability [7, 23], reduces inflammation [28, 29], and provides superior controls of fluid overload [30], hyperphosphatemia [31], anemia [15, 32], left ventricular hypertrophy [33], artery endothelial function [34], and propensity for serum calcification [35]. The reduction in cardiovascular mortality has been previously published [8-10].…”

Hope for CKD-MBD Patients: New Diagnostic Approaches for Better Treatment of CKD-MBD

“…The exposure of these cells to secondary CPPs results in the aforementioned triad of calcification, oxidative stress, and the release of inflammatory cytokines, a combination which is also commonly encountered in renal patients. Furthermore, macrophages exhibit a strong inflammatory response when exposed to secondary CPPs [67] .…”

“…Specifically, interventions such as hemodialysis [67][68][69] , increasing bicarbonate and magnesium, and lowering phosphate serum concentrations improve the T 50 value [56,68] . Uniform interventions, even of moderate intensity, have been shown to improve the T 50 value by approximately 40 min in hemodialysis and CKD patients [69] .…”