title: High-Flux Hemodialysis and High-Volume Hemodiafiltration Improve Serum Calcification Propensity.
abstract: BACKGROUND
  Calciprotein particles (CPPs) may play an important role in the calcification process. The calcification propensity of serum (T50) is highly predictive of all-cause mortality in chronic kidney disease patients. Whether T50 is therapeutically improvable, by high-flux hemodialysis (HD) or hemodiafiltration (HDF), has not been studied yet.
  
  
  METHODS
  We designed a cross-sectional single center study, and included stable prevalent in-center dialysis patients on HD or HDF. Patients were divided into two groups based on dialysis modality, were on a thrice-weekly schedule, had a dialysis vintage of > 3 months and vascular access providing a blood flow rate > 300 ml/min. Calcification propensity of serum was measured by the time of transformation from primary to secondary CPP (T50 test), by time-resolved nephelometry.
  
  
  RESULTS
  We included 64 patients, mean convective volume was 21.7L (SD 3.3L). In the pooled analysis, T50 levels increased in both the HD and HDF group with pre- and post-dialysis (mean (SD)) of 244(64) - 301(57) and 253(55) - 304(61) min respectively (P = 0.43(HD vs. HDF)). The mean increase in T50 was 26.29% for HD and 21.97% for HDF patients (P = 0.61 (HD vs. HDF)). The delta values (Δ) of calcium, phosphate and serum albumin were equal in both groups. Baseline T50 was negatively correlated with phosphate, and positively correlated with serum magnesium and fetuin-A. The ΔT50 was mostly influenced by Δ phosphate (r = -0.342; P = 0.002 HD and r = -0.396; P<0.001 HDF) in both groups.
  
  
  CONCLUSIONS
  HD and HDF patients present with same baseline T50 calcification propensity values pre-dialysis. Calcification propensity is significantly improved during both HD and HDF sessions without significant differences between both modalities.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.|Department of Internal Medicine, Division of Nephrology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Marijke
authors.initials: M
authors.lastname: Dekker
authors.affiliation: Department of Clinical Chemistry, University Hospital Bern, Bern, Switzerland.|Department of Clinical Research, University of Bern, Bern, Switzerland.|Calciscon AG, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pasch
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van der Sande
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Constantijn
authors.initials: C
authors.lastname: Konings
authors.affiliation: Department of Clinical Research, University of Bern, Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bachtler
authors.affiliation: Calciscon AG, Bern, Switzerland.
authors.forename: Mauro
authors.initials: M
authors.lastname: Dionisi
authors.affiliation: Calciscon AG, Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Meier
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Kooman
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
mesh_terms: D000368:Aged; D002113:Calcification, Physiologic / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D006435:Renal Dialysis / Q000379:methods*; D060749:alpha-2-HS-Glycoprotein / Q000032:analysis*
chemical_list: C556354:AHSG protein, human; D010710:Phosphates; D060749:alpha-2-HS-Glycoprotein