title: Is the dialysate calcium concentration of 1.75 mmol/L suitable for Chinese patients on maintenance hemodialysis?
abstract: We studied the effects of increasing the dialysate calcium concentration (DCa) to 1.75 mmol/L on controlling chronic kidney disease-mineral and bone disorder in Chinese patients on maintenance hemodialysis (MHD). We reviewed the data of MHD patients in one center (cohort 1) during prior 10 years and analyzed the risk factors of mortality and transference calcification (TC) in120 MHD patients surviving in 2003 (cohort 2). A multicenter, prospective, parallel-group, controlled trial (cohort 3) was also conducted from January 2011 to December 2012. The DCa at one center was increased from 1.5 to 1.75 mmol/L but was not changed at the other two centers. The clinical outcomes, biochemical parameters, medicine treatments, and TC markers [aortic arch calcification score (AoACS)] were compared between groups. In cohort 1, the annual mean serum iPTH increased significantly over 10 years. In cohort 1, 72 patients survived for 10 years, whose doses of calcium salts and active vitamin D3 and AoACs increased progressively. In cohort 2, the main cause of death was cardiocerebrovascular disease (CCVD) (n = 18, 48.6 %). Male sex and lower serum calcium concentrations were independent risk factors for CCVD mortality. In cohort 3, serum phosphorus, iPTH, and 25(OH)D decreased and serum calcium increased significantly; also, the doses of calcium and vitamin D3 decreased from 2011 to 2012 in the DCa 1.75 group. There were no significant differences in clinical outcomes either between groups or between the two calendar years. Our results indicate that increasing DCa to 1.75 mmol/L can decrease the elevated levels of serum iPTH and phosphorus, reduce the doses of calcium and vitamin D3, and be safe for short periods of time.
authors.affiliation: Nephrology Faculty, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Street, Xi-Cheng District, Beijing, 100050, China.
authors.forename: Dong-liang
authors.initials: DL
authors.lastname: Zhang
authors.forename: Li-yan
authors.initials: LY
authors.lastname: Wang
authors.forename: Fang
authors.initials: F
authors.lastname: Sun
authors.forename: Yi-lun
authors.initials: YL
authors.lastname: Zhou
authors.forename: Xiao-feng
authors.initials: XF
authors.lastname: Duan
authors.forename: Sha
authors.initials: S
authors.lastname: Liu
authors.forename: Yi
authors.initials: Y
authors.lastname: Sun
authors.forename: Tai-gen
authors.initials: TG
authors.lastname: Cui
authors.forename: Wen-hu
authors.initials: WH
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002118:Calcium / Q000097:blood* / Q000494:pharmacology*; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods
chemical_list: D015314:Dialysis Solutions; D010281:Parathyroid Hormone; D010710:Phosphates; D010758:Phosphorus; D002118:Calcium