Abstract
We studied the effects of increasing the dialysate calcium concentration (DCa) to 1.75 mmol/L on controlling chronic kidney disease–mineral and bone disorder in Chinese patients on maintenance hemodialysis (MHD). We reviewed the data of MHD patients in one center (cohort 1) during prior 10 years and analyzed the risk factors of mortality and transference calcification (TC) in120 MHD patients surviving in 2003 (cohort 2). A multicenter, prospective, parallel-group, controlled trial (cohort 3) was also conducted from January 2011 to December 2012. The DCa at one center was increased from 1.5 to 1.75 mmol/L but was not changed at the other two centers. The clinical outcomes, biochemical parameters, medicine treatments, and TC markers [aortic arch calcification score (AoACS)] were compared between groups. In cohort 1, the annual mean serum iPTH increased significantly over 10 years. In cohort 1, 72 patients survived for 10 years, whose doses of calcium salts and active vitamin D3 and AoACs increased progressively. In cohort 2, the main cause of death was cardiocerebrovascular disease (CCVD) (n = 18, 48.6 %). Male sex and lower serum calcium concentrations were independent risk factors for CCVD mortality. In cohort 3, serum phosphorus, iPTH, and 25(OH)D decreased and serum calcium increased significantly; also, the doses of calcium and vitamin D3 decreased from 2011 to 2012 in the DCa 1.75 group. There were no significant differences in clinical outcomes either between groups or between the two calendar years. Our results indicate that increasing DCa to 1.75 mmol/L can decrease the elevated levels of serum iPTH and phosphorus, reduce the doses of calcium and vitamin D3, and be safe for short periods of time.
Similar content being viewed by others
References
Jadoul M, Albert JM, Akiba T et al (2006) Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int 70:1358–1366
Block GA, Klassen PS, Lazarus JM et al (2004) Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 15:2208–2218
Kalantar-Zadeh K, Kuwae N, Regidor DL et al (2006) Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int 70:771–780
Tentori F, Blayney MJ, Albert JM et al (2008) Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 52:519–530
Floege J, Kim J, Ireland E et al (2011) Serum iPTH, calcium and phosphate, and the risk of mortality in a European hemodialysis population. Nephrol Dial Transpl 26(6):1948–1955
Goodman WG, Goldin J, Kuizon BD et al (2000) Coronary artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483
Raggi P, Boulay A, Chasan-Taber S et al (2002) Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol 39:695–701
National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(Suppl 3):S1–S202
Guideline Working Group, Japanese Society for Dialysis Therapy (2008) Clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial 12:514–525
Kidney Disease: Improving Global Outcomes (KDIGO) CKD–MBD Work Group (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD–MBD). Kidney Int 76(Suppl 113):S1–S130
Lezaic V, Pejanovic S, Kostic S et al (2007) Effects of lowering dialysate calcium concentration on mineral metabolism and parathyroid hormone secretion: a multicentric study. Ther Apher Dial 11:121–130
Spasovski G, Gelev S, Masin-Spasovska J et al (2007) Improvement of bone and mineral parameters related to adynamic bone disease by diminishing dialysate calcium. Bone 41:698–703
Toussaint N, Cooney P, Kerr PG (2006) Review of dialysate calcium concentration in hemodialysis. Hemodial Int 10:326–337
Beijing Hemodialysis Record Data System (2011) 2010 Annual report on hemodialysis in Beijing. Chin J Blood Purif 10:19–21
Ogawa T, Ishida H, Matsuda N et al (2009) Simple evaluation of aortic arch calcification by chest radiography in hemodialysis patients. Hemodial Int 13:301–306
Dialysis Outcomes and Practice Patterns Study (2010) DOPPS annual report. http://www.dopps.org/annualreport/index.htm. Accessed 23 Feb 2013
Hwang JC, Chen CA, Wang CT et al (2008) Long-term effect of different dialysate calcium concentrations on parathyroid hormone levels in hemodialysis patients. Ren Fail 30(10):943–949
Gabutti L, Bianchi G, Soldini D et al (2009) Haemodialysis consequences of changing bicarbonate and calcium concentrations in haemodialysis fluids. Nephrol Dial Transpl 24(2):973–981
Al-Hejaili F, Kortas C, Leitch R et al (2003) Nocturnal but not short hours quotidian hemodialysis requires an elevated dialysate calcium concentration. J Am Soc Nephrol 14:2322–2328
Asci G, Ok E, Savas R et al (2011) The link between bone and coronary calcifications in CKD-5 patients on haemodialysis. Nephrol Dial Transpl 26:1010–1015
West SL, Swan VJ, Jamal SA (2008) Effects of calcium on cardiovascular events in patients with kidney disease and in a healthy population. Clin J Am Soc Nephrol 5(Suppl 1):S41–S47
Yamada K, Fujimoto S, Nishiura R et al (2007) Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis. Nephrol Dial Transpl 22:2032–2037
Dabrowski J, Stazka J, Janicka L et al (2004) Calcification of heart valves in hemodialyzed patients and their cardiosurgical correction. Kardiol Pol 61(8):151–155
Kim J-K, Moon SJ, Park HC et al (2011) Effects of lowering dialysate calcium concentrations on arterial stiffness in patients undergoing hemodialysis. Korean J Intern Med 26:320–327
LeBeouf A, Mac-Way F, Utescu MS et al (2009) Effects of acute variation of dialysate calcium concentrations on arterial stiffness and aortic pressure waveform. Nephrol Dial Transpl 24(2):3788–3794
Goodkin DA, Bragg-Gresham JL, Koenig KG et al (2003) Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol 10:3270–3277
Hou F, Jiang J, Chen J et al (2012) China collaborative study on dialysis: a multi-center cohort study on cardiovascular diseases in patients on maintenance dialysis. BMC Nephrol 13:94–102
Floege J, Kim J, Ireland E et al (2011) Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transpl 26:1948–1955
Joosen IA, Schiphof F, Versteylen MO et al (2012) Relation between mild to moderate chronic kidney disease and coronary artery disease determined with coronary CT angiography. PLoS One 7(10):e47267
Lee MJ, Shin DH, Kim SJ et al (2012) Progression of aortic arch calcification over 1 year is an independent predictor of mortality in incident peritoneal dialysis patients. PLoS One 7(11):e48793
Markaki A, Kyriazis J, Stylianou K et al (2012) The role of serum magnesium and calcium on the association between adiponectin levels and all-cause mortality in end-stage renal disease patients. PLoS One 7(12):e52350
Jean G, Lataillade D, Genet L et al (2013) Higher dialysate calcium is not associated with mortality in hemodialysis patients: results from the French ARNOS study [in French]. Nephrol Ther 9:103–107
Sigrist MK, Taal MW, Bungay P et al (2007) Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease. Clin J Am Soc Nephrol 2:1241–1248
Kim HG, Song SW, Kim TY et al (2011) Risk factors for progression of aortic arch calcification in patients on maintenance hemodialysis and peritoneal dialysis. Hemodial Int 15:460–467
Pencak P, Czerwieńska B, Ficek R et al (2013) Calcification of coronary arteries and abdominal aorta in relation to traditional and novel risk factors of atherosclerosis in hemodialysis patients. BMC Nephrol 14:10–18
Coen G, Pierantozzi A, Spizzichino D et al (2010) Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients. BMC Nephrol 11:10–18
Dukkipati R, Kovesdy CP, Kim Y et al (2010) Association of relatively low serum parathyroid hormone with malnutrition–inflammation complex and survival in maintenance hemodialysis patients. J Ren Nutr 20(4):243–254
Kong X, Zhang L, Zhang L et al (2012) Mineral and bone disorder in Chinese dialysis patients: a multicenter study. BMC Nephrol 13:116–123
Beijing Dialysis and Transplantation Registration Group (2001) The report about the registration of dialysis and transplantation in Beijing 1999. Chin J Nephrol 17(2):79–82
US Renal Data System (2012) Atlas of ESRD 2010. http://www.usrds.org/2012/view/v2_05.aspx. Accessed 23 Feb 2013
Seyffart G, Schulz T, Stiller S (2009) Use of two calcium concentrations in hemodialysis—report of a 20-year clinical experience. Clin Nephrol 71(3):296–305
Acknowledgments
This project was supported by the Capital Health Research and Development Project (2011-2002-02), the Beijing Municipal Science and Technology Commission Funds (Z121107001012138), and the Beijing Natural Science Foundation (7132091).
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have stated that they have no conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Zhang, Dl., Wang, Ly., Sun, F. et al. Is the Dialysate Calcium Concentration of 1.75 mmol/L Suitable for Chinese Patients on Maintenance Hemodialysis?. Calcif Tissue Int 94, 301–310 (2014). https://doi.org/10.1007/s00223-013-9811-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00223-013-9811-x