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Higher dialysate calcium concentration is associated with incident myocardial infarction among diabetic patients with

Miho Tagawa1, Takayuki Hamano2, Shinichi Sueta3

  • 1Department of Nephrology, Nara Medical University, Kashihara, Japan. tagawam@naramed-u.ac.jp.

Scientific Reports
|July 4, 2018
PubMed

Insights

Higher dialysate calcium (D[Ca]) levels are linked to myocardial infarction (MI) in hemodialysis patients with diabetes mellitus (DM). This risk is amplified in DM patients with low serum calcium or intact parathyroid hormone (iPTH) levels.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Cardiovascular events are a leading cause of mortality in hemodialysis patients.
  • Dialysate calcium concentration (D[Ca]) is a modifiable factor in hemodialysis.
  • The relationship between D[Ca] and cardiovascular events, particularly myocardial infarction (MI), requires further elucidation, especially in specific patient subgroups like those with diabetes mellitus (DM).

Purpose of the Study:

  • To investigate the association between higher dialysate calcium (D[Ca] ≥3.0 mEq/L) and the risk of first cardiovascular (CV) events in hemodialysis patients.
  • To examine the effect modification of diabetes mellitus (DM) on the D[Ca] and CV event association.
  • To explore the influence of serum calcium, intact parathyroid hormone (iPTH), and intradialytic changes in serum calcium (ΔCa) on this association.

Main Methods:

  • Longitudinal study of 53,560 hemodialysis patients from the Japan Renal Data Registry.
  • Predictor: D[Ca] ≥3.0 vs 2.5 mEq/L.
  • Outcomes: First CV events during a 1-year observation period. Multivariate logistic regression analyses were used to test associations and effect modifications.

Main Results:

  • Higher D[Ca] was significantly associated with an increased risk of myocardial infarction (MI) in patients with DM (OR: 1.26 [1.03-1.55]).
  • Diabetes mellitus (DM) acted as a significant effect modifier (p for interaction <0.01).
  • The association was particularly strong in DM patients with low serum calcium or low iPTH levels (≤60 pg/mL) and was attenuated by adjustment for ΔCa, suggesting a role for intradialytic calcium shifts.

Conclusions:

  • Higher dialysate calcium (D[Ca]) is associated with incident myocardial infarction (MI) in hemodialysis patients with diabetes mellitus (DM).
  • This association is more pronounced in DM patients with low serum calcium or low intact parathyroid hormone (iPTH) levels.
  • The findings suggest that increased calcium influx during dialysis, especially in DM patients with low bone turnover markers, may contribute to vascular calcification and subsequent MI.

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