Korean J Intern Med.  2011 Sep;26(3):320-327. 10.3904/kjim.2011.26.3.320.

Effects of Lowering Dialysate Calcium Concentrations on Arterial Stiffness in Patients Undergoing Hemodialysis

• Kim JK
• Moon SJ
• Park HC
• Lee JS
• Sim SR
• Bae SC
• Ha SK

• KMID: 1022172
• DOI: http://doi.org/10.3904/kjim.2011.26.3.320

Abstract

BACKGROUND/AIMS
We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis.
METHODS
In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A.
RESULTS
During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 +/- 1.0 to 9.0 +/- 0.7, p = 0.002 vs. 1.3 +/- 0.1 to 1.1 +/- 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 +/- 45.8 pmol/mL at baseline to 124.9 +/- 82.2 pmol/mL at 6 months, p = 0.043).
CONCLUSIONS
Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.

Keyword

Arterial stiffness; Calcium; Dialysis solutions; Fetuin A; Hemodialysis

MeSH Terms

Aged
Analysis of Variance
Ankle Brachial Index
Arteries/*drug effects/physiopathology
Biological Markers/blood
Blood Pressure/drug effects
Calcium/*administration & dosage/adverse effects
Compliance
Female
Hemodialysis Solutions/*administration & dosage/adverse effects/chemistry
Humans
Male
Middle Aged
Prospective Studies
Pulsatile Flow/*drug effects
*Renal Dialysis
Republic of Korea
Time Factors
Treatment Outcome
alpha-2-HS-Glycoprotein/metabolism