title: Arterial stiffness depends on serum ionized calcium levels during dialysis with regional citrate anticoagulation.
abstract: Hemodynamic effects related to changes in serum ionized calcium (iCa) are difficult to determine during conventional hemodialysis (HD) using a fixed dialysate concentration of calcium. Regional citrate anticoagulation (RCA) allows the study of the effects of predefined iCa changes on arterial stiffness and blood pressure (BP) during a single dialysis session. In a crossover study, 15 patients with end-stage renal disease underwent two HD sessions with RCA. Each session was divided into two study phases in which iCa was titrated either to 0.8-1.0 mm or to 1.1-1.4 mm. The sequence of phases was randomly chosen and alternated for the second session. After reaching a stable iCa level, pulse wave velocity (PWV), arterial BP, and heart rate were measured. iCa levels were modified during sequence 1 (iCa low-high) from a predialysis baseline value of 1.15 ± 0.09 mm, first to 0.92 ± 0.05 mm (time point 1; P < 0.001 vs. baseline) and then to 1.18 ± 0.05 (time point 2; ns). During sequence 2 (iCa high-low), iCa levels were modified from 1.15 ± 0.12 mm first to 1.20 ± 0.05 mm (time point 1; ns vs. baseline) and then to 0.93 ± 0.03 (time point 2; P < 0.001). Assuming a basic linear repeated measures model, PWV was positively related to iCa levels (P < 0.03) independent of systolic or diastolic BP, heart rate, or ultrafiltration rate. PWV is closely related to acute changes in serum iCa levels in HD patients using RCA. RCA provides an interesting opportunity to study the effects of acute iCa changes during one dialysis procedure.
authors.affiliation: Department of Nephrology and Hypertension, University Hospital of Bern, Bern, Switzerland.
authors.forename: Matthias B
authors.initials: MB
authors.lastname: Moor
authors.forename: Anja
authors.initials: A
authors.lastname: Kruse
authors.forename: Dominik E
authors.initials: DE
authors.lastname: Uehlinger
authors.forename: Ute
authors.initials: U
authors.lastname: Eisenberger
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D019343:Citric Acid / Q000008:administration & dosage*; D018592:Cross-Over Studies; D005260:Female; D005858:Germany; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D019343:Citric Acid; D002118:Calcium