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Effect of Hemodialysis With Citrate on Vascular Calcification

W Charles O'Neill1, Jose Navarrete1, Michelle Young1

  • 1Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Kidney International Reports
|July 1, 2026
PubMed

Insights

Citrate in hemodialysis (HD) unexpectedly accelerated vascular calcification in patients with end-stage renal disease (ESRD). This study found increased medial arterial calcification progression with citrate-containing HD solutions, highlighting potential risks.

Area of Science:

  • Nephrology
  • Vascular Biology
  • Biomineralization

Background:

  • Vascular calcification is common in hemodialysis (HD) patients with end-stage renal disease (ESRD), leading to poor clinical outcomes.
  • Citrate, sometimes used in HD solutions, was hypothesized to inhibit vascular calcification.

Purpose of the Study:

  • To investigate the effect of citrate in HD solutions on the progression of medial arterial calcification in female ESRD patients.

Main Methods:

  • A cross-over study involving 28 female HD patients with pre-existing breast arterial calcification (BAC).
  • Patients received HD with and without citrate dialysate for 1 year each, with BAC measured every 6 months.
  • Citrate levels were measured in calcified human arteries.

Main Results:

  • HD with citrate significantly increased post-HD plasma citrate levels.
  • Progression of BAC was substantially greater during citrate HD compared to non-citrate HD (47 vs. 9 mm/yr).
  • Citrate was detected in calcified arteries and correlated with the degree of calcification.

Conclusions:

  • Citrate in HD unexpectedly promoted vascular calcification, contrary to the initial hypothesis.
  • The findings suggest citrate may enhance biomineralization, similar to its role in bone formation.
  • Further research is needed to assess the clinical implications of citrate-induced vascular calcification in HD patients.
Abstract

Keywords:
citratehemodialysisvascular calcification

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