Reduction of Dialysate Calcium Level Reduces Progression of Coronary Artery Calcification and Improves Low Bone Turnover in Patients on Hemodialysis

• Published in: Journal of the American Society of Nephrology Vol. 27; no. 8; pp. 2475 - 2486
• Main Authors: Ok, Ercan, Asci, Gulay, Bayraktaroglu, Selen, Toz, Huseyin, Ozkahya, Mehmet, Yilmaz, Mumtaz, Kircelli, Fatih, Sevinc Ok, Ebru, Ceylan, Naim, Duman, Soner, Cirit, Mustafa, Monier-Faugere, Marie-Claude, Malluche, Hartmut H
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.08.2016
• Subjects: Bone Remodeling; Calcium - analysis; Clinical Research; Coronary Artery Disease - etiology; Coronary Artery Disease - prevention & control; Disease Progression; Female; Hemodialysis Solutions - chemistry; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Middle Aged; Prospective Studies; Renal Dialysis; Vascular Calcification - etiology; Vascular Calcification - prevention & control; hemodialysis; mineral metabolism; vascular calcification
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/asn.2015030268

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 1.50 mmol/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 452±869 (mean±SD) in the 1.25 Ca group and 500±909 in the 1.75 Ca group (P=0.68) at baseline to 616±1086 and 803±1412, 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 low bone turnover decreased from 85.0% 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.