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Dialysate Calcium Concentration below 3.0 mEq/L Is Not Associated with Improved Outcomes in the Japanese Dialysis
Kunitoshi Iseki1, Lisa L Henn2, Takanobu Nomura3
1Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japanchihokun_ohra@yahoo.co.jp.
Insights
Higher dialysate calcium (D-Ca) levels in hemodialysis patients were not linked to increased mortality or cardiovascular events. Lowering D-Ca below 3.0 mEq/L showed no significant impact on patient outcomes in this study.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Mineral and Bone Disorder
Background:
- Abnormal chronic kidney disease-mineral and bone disorder (CKD-MBD) markers are linked to adverse outcomes in hemodialysis (HD) patients.
- Dialysate calcium concentration (D-Ca) influences serum calcium and phosphorus levels, but optimal levels remain unclear.
- This study investigated the association between D-Ca and cardiovascular events/mortality in Japanese HD patients.
Purpose of the Study:
- To determine if higher dialysate calcium concentration (D-Ca) is associated with cardiovascular events and mortality in Japanese hemodialysis patients.
- To evaluate the impact of different D-Ca levels (2.5, 2.75, and 3.0 mEq/L) on patient outcomes.
- To clarify the optimal D-Ca level for hemodialysis patients.
Main Methods:
- Analysis of enrollment data from the prospective observational study JDOPPS, phases 1-5 (1999-2015).
- Evaluation of all-cause mortality and non-arrhythmic cardiovascular events (NonAR-CVE) by D-Ca levels, restricting analyses to facilities with uniform D-Ca prescriptions (≥90% of patients).
- Cox models stratified by phase and accounting for facility clustering were used, adjusting for patient and facility covariates.
Main Results:
- Of 9,201 patients, 68.2% used D-Ca 3.0 mEq/L, 25.0% used 2.5 mEq/L, and 6.8% used 2.75 mEq/L.
- D-Ca levels were not significantly associated with all-cause mortality or NonAR-CVE.
- A potential protective effect of lower D-Ca on NonAR-CVE was observed in patients without cardiovascular comorbidities, but this was not significant after multiple comparisons adjustment.
Conclusions:
- Lowering dialysate calcium (D-Ca) concentration below 3.0 mEq/L does not appear to significantly impact patient outcomes in hemodialysis.
- The study did not find a meaningful association between D-Ca levels and major adverse events in this Japanese HD population.
- Further research may be needed to explore nuanced effects of D-Ca in specific patient subgroups.
Background:
Abnormal chronic kidney disease-mineral and bone disorder (CKD-MBD) markers have been associated with adverse outcomes in hemodialysis (HD) patients. Dialysate calcium concentration (D-Ca) likely influences serum calcium and phosphorus levels. Optimal D-Ca level remains unclear. We hypothesized that higher D-Ca is associated with cardiovascular events and mortality among Japanese HD patients.
Methods:
Enrollment data of chronic HD patients in the prospective observational study JDOPPS, phases 1-5 (1999-2015), provided exposures and covariates. All-cause mortality, non-arrhythmic cardiovascular events (NonAR-CVE), or their composites were analyzed by D-Ca, and divided into 2.5, 2.75, and 3.0 mEq/L. To minimize confounding by indication, analyses were restricted to facilities in which at least 90% of patients received the same D-Ca prescription. Association of D-Ca level with outcomes was evaluated in Cox models stratified by phase and accounting for facility clustering. Covariates describing patient demographics, comorbidities, laboratory values, CKD-MBD therapy, and facility attributes provided adjustment.
Results:
Of 9,201 patients included, 25.0% had D-Ca of 2.5 mEq/L; 6.8% D-Ca 2.75; and 68.2% D-Ca 3.0. Median follow-up time was 2.03 years. D-Ca was not associated with all-cause mortality, with hazards ratios for 2.5 vs. 3.0 mEq/L of 0.90 and 95% CI (0.73-1.11), nor with other outcomes. One effect modification occurred, protective for lower D-Ca on NonAR-CVE in the absence of cardiovascular comorbidities (p = 0.032), although corresponding D-Ca effects were not significant after multiple comparisons adjustment (p = 0.261 [D-Ca 2.5] and 0.125 [D-Ca 2.75]).
Conclusion:
Lowering D-Ca level below 3.0 mEq/L seems not to have a meaningful effect on patient outcomes.
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