Reduction of dialysate calcium level reduces progression of coronary artery calcification and improves low bone turnover in patients on hemodialysis

Ercan Ok, Gulay Asci, Selen Bayraktaroglu, Huseyin Toz, Mehmet Ozkahya, Mumtaz Yilmaz, Fatih Kircelli, Ebru Sevinc Ok, Naim Ceylan, Soner Duman, Mustafa Cirit, Marie Claude Monier-Faugere, Hartmut H. Malluche

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53 Scopus citations

Abstract

Exposure to high Ca concentrations may influence the development of low-turnover bone disease and coronary artery calcification (CAC) in patients on hemodialysis (HD). In this randomized, controlled study, we investigated the effects of lowering dialysate Ca level on progression of CAC and histologic bone abnormalities in patients on HD. Patients on HD with intact parathyroid hormone levels #300 pg/ml receiving dialysate containing 1.75 or 1.50mmol/L Ca (n=425) were randomized to the 1.25-mmol/L Ca (1.25 Ca; n=212) or the 1.75-mmol/L Ca (1.75 Ca; n=213) dialysate arm. Primary outcome was a change in CAC score measured by multislice computerized tomography; main secondary outcome was a change in bone histomorphometric parameters determined by analysis of bone biopsy specimens. CAC scores increased from 4526869 (mean6SD) in the 1.25 Ca group and 5006909 in the 1.75 Ca group (P=0.68) at baseline to 61661086 and 80361412, respectively, at 24 months (P=0.25). Progression rate was significantly lower in the 1.25 Ca group than in the 1.75 Ca group (P=0.03). The prevalence of histologically diagnosed lowbone turnover decreased from85.0% to 41.8%in the 1.25 Ca group (P=0.001) and did not change in the 1.75 Ca group. At 24 months, bone formation rate, trabecular thickness, and bone volume were higher in the 1.25 Ca group than in the 1.75 Ca group. Thus, lowering dialysate Ca levels slowed the progression of CAC and improved bone turnover in patients on HD with baseline intact parathyroid hormone levels #300 pg/ml.

Original languageEnglish
Pages (from-to)2475-2486
Number of pages12
JournalJournal of the American Society of Nephrology
Volume27
Issue number8
DOIs
StatePublished - 2016

Bibliographical note

Publisher Copyright:
Copyright © 2016 by the American Society of Nephrology.

ASJC Scopus subject areas

  • Nephrology

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