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Nephron. 2018;140(4):240-248. doi: 10.1159/000493470. Epub 2018 Oct 19.

Dialysate Calcium Concentration below 3.0 mEq/L Is Not Associated with Improved Outcomes in the Japanese Dialysis Outcomes and Practice Patterns Study.

Author information

1
Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japanchihokun_ohra@yahoo.co.jp.
2
Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
3
Medical Affairs, Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan.
4
Department of Nephrology, Tokyo Kyosai Hospital, Tokyo, Japan.
5
Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan.
6
Fukuoka Renal Clinic, Fukuoka, Japan.
7
Department of Internal Medicine, Michigan Medicine, and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
8
DaVita Clinical Research, Minneapolis, Minnesota, USA.

Abstract

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.

KEYWORDS:

Cardiovascular comorbidity; Dialysate calcium; Effect modification; Japanese Dialysis Outcomes and Practice Patterns Study; Non-arrhythmic cardiovascular event

PMID:
30343299
DOI:
10.1159/000493470

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