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The impact of low and high dialysate calcium concentrations on cardiovascular disease and death in patients
Keita Kamei1, Shunsuke Yamada2, Koji Hashimoto3
1Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan. k.kamei@med.id.yamagata-u.ac.jp.
Clinical and Experimental Nephrology
|February 24, 2024
Summary
Low-calcium dialysate (LCD) did not significantly impact cardiovascular calcification or death in hemodialysis patients compared to high-calcium dialysate (HCD). However, LCD improved vascular function markers, suggesting potential benefits despite inconclusive evidence.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Trials
Background:
- The optimal dialysate calcium concentration for hemodialysis patients, particularly for cardiovascular protection, remains uncertain.
- Existing research provides conflicting evidence on the impact of different dialysate calcium levels on patient outcomes.
Approach:
- A systematic review and meta-analysis of 19 and 8 randomized controlled trials (RCTs), respectively, were conducted.
- The study compared low-calcium dialysate (LCD) with high-calcium dialysate (HCD) in maintenance hemodialysis patients.
- Outcomes assessed included coronary artery calcification score (CACS), mortality, cardiovascular function, and serum biochemistry.
Key Points:
- No significant differences were observed in CACS, all-cause death, or cardiovascular death between LCD and HCD groups.
- LCD was associated with significantly reduced intima-media thickness and pulse wave velocity, indicating improved vascular health.
- LCD led to decreased serum calcium and increased parathyroid hormone levels compared to HCD.
Conclusions:
- The meta-analysis found no significant differences in cardiovascular calcification or mortality between LCD and HCD.
- A notable limitation is the scarcity of RCTs, especially those including patients on calcimimetics.
- Further research is urgently needed to establish optimal dialysate calcium concentrations and their long-term effects, particularly in diverse patient populations.
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