High-calcium dialysate: a factor associated with inflammation, malnutrition and mortality in non-diabetic maintenance haemodialysis patients.
OBJECTIVE
Chronic inflammation, which is common in dialysis patients, often causes malnutrition and even protein-energy wasting. However, the association of high-calcium dialysate with malnutrition and/or inflammation in non-diabetic maintenance haemodialysis patients remains unclear. This study investigated the possible adverse effects of high-calcium dialysate and mortality in this population.


METHODS
A total of 717 non-diabetic haemodialysis patients participated in this 2 year prospective study. The subjects were categorized into three subgroups based on whether dialysate calcium concentrations were high (3.5 mEq/L), standard (3.0 mEq/L) or low (2.5 mEq/L). Demographic, haematological, nutritional and inflammatory markers, biochemical and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup.


RESULTS
Patients with high-calcium dialysate (n = 82) had a higher incidence of malnutrition and inflammation (61.0% vs 44.1% and 43.9%, respectively) than those with standard- and low-calcium dialysate (n = 528 and 107). Backward stepwise multiple regression analysis revealed that high-calcium dialysate was negatively correlated with nutritional index, serum albumin levels, but positively associated with the inflammatory marker of serum ferritin levels. At the end of the 2 year follow up, 45 patients had died. Cox multivariate analysis demonstrated that high-calcium dialysate was a significant associated factor (relative risk 2.765; 95% confidence interval 1.429-5.352) for 2 year all-cause mortality in these patients.


CONCLUSIONS
The analytical results indicate that high-calcium dialysate is associated with malnutrition and inflammation as well as 2 year mortality in non-diabetic maintenance haemodialysis patients and the findings suggest that this population, even those with optimal mineral balance, should avoid high-calcium dialysate.
Hsu
Ching-Wei
CW
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, 199 Tung-Hwa North Road, Taipei 100, Taiwan.
Lin
Ja-Liang
JL
Lin-Tan
Dan-Tzu
DT
Yen
Tzung-Hai
TH
Chen
Kuan-Hsing
KH
Huang
Wen-Hung
WH
Ho
Tai-Chin
TC
Huang
Yen-Lin
YL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000009:adverse effects*; D002423:Cause of Death; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015312:Hemodialysis Solutions / Q000009:adverse effects*; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D018836:Inflammation Mediators / Q000097:blood; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D008875:Middle Aged; D009752:Nutritional Status; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D015312:Hemodialysis Solutions; D018836:Inflammation Mediators; D002118:Calcium