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Association of calciprotein particles with serum phosphorus among patients undergoing conventional and extended-hours
Nobuhiro Nishibori1, Masaki Okazaki1,2,3, Yutaka Miura4
1Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
Extended-hours haemodialysis (HD) significantly lowers calciprotein particles (CPPs) compared to conventional HD. This reduction in CPPs, a marker for vascular calcification, may explain improved clinical outcomes in patients receiving extended HD therapy.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biochemistry
Background:
- Extended-hours haemodialysis (HD) is linked to superior clinical outcomes compared to conventional HD.
- Calciprotein particles (CPPs) and phosphorus are implicated in vascular calcification pathogenesis.
Purpose of the Study:
- To investigate the differential effects of extended-hours HD versus conventional HD on blood levels of calciprotein particles (CPPs) and phosphorus.
- To examine the association between CPPs and serum phosphorus across different HD modalities.
Main Methods:
- A cohort study included 382 patients undergoing conventional or extended in-centre daytime HD.
- Plasma CPP levels (CPP-II) were measured in pre-dialysis samples.
- Linear and non-linear regression analyses assessed associations between CPPs and serum phosphorus.
Main Results:
- Extended-hours HD patients (n=185) had significantly lower plasma CPP (CPP-II) levels than conventional HD patients (n=197) [40,018 AU vs 75,728 AU; P < .01].
- Multivariable regression confirmed extended-hours HD was associated with lower ln(CPP-II) levels.
- Extended-hours HD showed lower CPP levels across serum phosphorus ranges, particularly in hyperphosphataemia (P interaction < .01).
Conclusions:
- Extended-hours HD is associated with reduced calciprotein particle levels compared to conventional HD.
- Lower CPP levels in extended-hours HD may contribute to the observed better clinical outcomes.
- These findings highlight the potential benefit of extended HD in managing vascular calcification risk.
Background And Hypothesis:
Extended-hours haemodialysis (HD) is associated with better clinical outcomes than conventional HD. We investigated whether extended-hours HD and conventional HD have varying effects on blood levels of calciprotein particles (CPPs) and phosphorus, which have been identified as major pathogenic molecules for vascular calcification.
Methods:
Patients who underwent conventional or extended in-centre daytime HD between January and March 2020 were included. Plasma CPP levels, representing only secondary CPPs (CPP-II), were measured in pre-dialysis samples. Linear and non-linear associations between CPPs and serum phosphorus levels were examined across dialysis modalities.
Results:
A total of 382 participants (185 undergoing extended-hours HD and 197 undergoing conventional HD) were included in the analysis. The median age of participants was 71 years, 65% of the patients were men and the mean phosphorus level was 5.4 mg/dl. Plasma CPP (CPP-II) levels were lower in the extended-hours HD group than in the conventional HD group [40 018 (arbitrary units) AU versus 75 728 AU; P < .01]. Multivariable linear regression analysis showed that extended-hours HD was associated with lower natural logarithmic plasma CPP (CPP-II) levels: -0.64 (95% confidence interval -0.74 to -0.55). A restricted cubic spline function indicated that extended-hours HD was associated with lower plasma CPP (CPP-II) levels across levels of serum phosphorus, with significant differences observed between groups, especially in hyperphosphataemic conditions (P for interaction <.01).
Conclusions:
The extended-hours HD group had lower CPP levels than the conventional HD group despite no significant differences in serum phosphorus levels, which may contribute to better clinical outcomes in patients on extended-hours HD.
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