title: Impact of Dialysate Calcium Concentration on Clinical Outcomes in Incident Hemodialysis Patients.
abstract: The association between dialysate calcium (DCa) concentration and mortality in hemodialysis (HD) patients is controversial. In this study, we evaluated the impact of DCa concentration on mortality in incident HD patient. Incident HD patients were selected from the Clinical Research Center registry-a prospective cohort study on dialysis patients in Korea. Patients were categorized into 3 groups according to the prescribed DCa concentration at the time of enrollment. High DCa was defined as a concentration of 3.5 mEq/L, mid-DCa as 3.0 mEq/L, and low DCa as 2.5 to 2.6 mEq/L. The primary outcome was all-cause mortality and secondary outcomes were cardiovascular or infection-related hospitalization. A total of 1182 patients with incident HD were included. The number of patients in each group was 182 (15.4%) in high DCa group, 701 (59.3%) in the mid-DCa group, and 299 (25.3%) in the low DCa group. The median follow-up period was 16 months. The high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.28-3.90, P = 0.005) and the low DCa group (HR 3.67, 95% CI 1.78-7.55, P < 0.001) after adjustment for clinical variables. The high DCa group was associated with higher risk of cardiovascular and infection-related hospitalization compared with the low DCa group (HR 3.25, 95% CI 1.53-6.89, P = 0.002; and HR 2.77, 95% CI 1.29-5.94, P =  .009, respectively). Of these 1182 patients, 163 patients from each group were matched by propensity scores. In the propensity score matched analysis, the high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (HR 2.52, 95% CI 1.04-6.07, P = 0.04) and the low DCa group (HR 4.25, 95% CI 1.64-11.03, P = 0.003) after adjustment for clinical variables. Our data showed that HD using a high DCa was a significant risk factor for all-cause mortality and cardiovascular or infection-related hospitalization in incident HD patients.
authors.affiliation: From the Department of Internal Medicine, College of Medicine, The Catholic University of Korea (DCJ, HWK, YOK, HCS, EJC, CWY, YKK); Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul (SHK); Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu (YLK); Department of Internal Medicine, College of Medicine, Seoul National University (YSK); Department of Internal Medicine, College of Medicine, Yonsei University, Seoul (SWK); and Department of Internal Medicine, Chonnam National University Medical School, Kwangju, St Vincent's Hospital, Suwon, Korea (NHK).
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Su-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Young Ok
authors.initials: YO
authors.lastname: Kim
authors.forename: Dong Chan
authors.initials: DC
authors.lastname: Jin
authors.forename: Ho Chul
authors.initials: HC
authors.lastname: Song
authors.forename: Euy Jin
authors.initials: EJ
authors.lastname: Choi
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.forename: Yon-Su
authors.initials: YS
authors.lastname: Kim
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Kim
mesh_terms: D000328:Adult; D002118:Calcium; D015314:Dialysis Solutions / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality*; D056910:Republic of Korea; D012307:Risk Factors
chemical_list: D015314:Dialysis Solutions; D002118:Calcium