Effects of Lowering Dialysate Calcium Concentrations on Arterial Stiffness in Patients Undergoing Hemodialysis.
10.3904/kjim.2011.26.3.320
- Author:
Jwa Kyung KIM
1
;
Sung Jin MOON
;
Hyeong Cheon PARK
;
Jae Sung LEE
;
Soung Rok SIM
;
Sung Chang BAE
;
Sung Kyu HA
Author Information
1. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. hask1951@yuhs.ac
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Arterial stiffness;
Calcium;
Dialysis solutions;
Fetuin A;
Hemodialysis
- MeSH:
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
- From:The Korean Journal of Internal Medicine
2011;26(3):320-327
- CountryRepublic of Korea
- Language:English
-
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.
