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Effects of lowering dialysate calcium concentrations on arterial stiffness in patients undergoing hemodialysis

Authors
 Jwa-Kyung Kim  ;  Sung Jin Moon  ;  Hyeong Cheon Park  ;  Jae Sung Lee  ;  Soung Rok Sim  ;  Sung Chang Bae  ;  Sung Kyu Ha 
Citation
 KOREAN JOURNAL OF INTERNAL MEDICINE, Vol.26(3) : 320-327, 2011 
Journal Title
KOREAN JOURNAL OF INTERNAL MEDICINE
ISSN
 1226-3303 
Issue Date
2011
MeSH
Aged ; Analysis of Variance ; Ankle Brachial Index ; Arteries/drug effects* ; Arteries/physiopathology ; Biomarkers/blood ; Blood Pressure/drug effects ; Calcium/administration & dosage* ; Calcium/adverse effects ; Compliance ; Female ; Hemodialysis Solutions/administration & dosage* ; Hemodialysis Solutions/adverse effects ; Hemodialysis Solutions/chemistry ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulsatile Flow/drug effects* ; Renal Dialysis* ; Republic of Korea ; Time Factors ; Treatment Outcome ; alpha-2-HS-Glycoprotein/metabolism
Keywords
Arterial stiffness ; Calcium ; Dialysis solutions ; Fetuin A ; Hemodialysis
Abstract
BACKGROUND/AIMS: We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis.

METHODS: In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A.

RESULTS: During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 ± 1.0 to 9.0 ± 0.7, p = 0.002 vs. 1.3 ± 0.1 to 1.1 ± 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 ± 45.8 pmol/mL at baseline to 124.9 ± 82.2 pmol/mL at 6 months, p = 0.043).

CONCLUSIONS: Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.
Files in This Item:
T201104693.pdf Download
DOI
10.3904/kjim.2011.26.3.320
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jwa Kyung(김좌경)
Park, Hyeong Cheon(박형천) ORCID logo https://orcid.org/0000-0002-1550-0812
Sim, Soung Rok(심성록)
Lee, Jae Sung(이재성)
Ha, Sung Kyu(하성규)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94772
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