Low versus high dialysate calcium concentration in alternate night nocturnal hemodialysis: A randomized controlled trial

Masterson, Rosemary; Blair, Susan; Polkinghorne, Kevan R.; Lau, Kenneth; Lian, Michael; Strauss, Boyd Josef Gimnicher; Morgan, John G.; Kerr, Peter G.; Toussaint, Nigel D

doi:10.1111/hdi.12452

Cited by 6 publications

(11 citation statements)

References 34 publications

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“…Consensus is lacking on the optimal dialysate calcium concentration, although high calcium dialysate may contribute to vascular calcification and aortic stiffness 41, 42, 43, 44, 45, 46, 47. Based on moderate quality of evidence, our findings strongly support use of low calcium dialysate to reduce aortic stiffness in ESRD.…”

Section: Discussionmentioning

confidence: 64%

“… 42 Parallel RCTUnclear risk biasfLow calcium (1.12 mmol/l)( n = 14)High calcium (1.37 mmol/l)( n = 13)68 ± 12;66 ± 1366 ± 4;6 ± 4Masterson et al. 43 Parallel RCTUnclear risk biasfLow calcium (1.3 mmol/l)( n = 22)High calcium (1.6 or 1.75 mmol/l)( n = 20)53 ± 21;48 ± 111225 ± 29g;16 ± 18gMarchais et al. 44 Parallel RCTHigh risk biasfLow calcium (1.50 mmol/l)( n = 13)High calcium (1.75 mmol/l)( n = 13)Not reportedSingle dialysisNot reportedMoor et al.…”

Section: Resultsmentioning

confidence: 99%

“…Seven hemodialysis studies41, 42, 43, 44, 45, 46, 47 reported effect estimates on use of low calcium ( n = 151) versus high calcium ( n = 110) dialysates (2 crossover studies) to reduce cf-PWV (Table 1; Figure 4). Only 5 studies41, 42, 44, 45, 47 reported SBP data.…”

Section: Resultsmentioning

confidence: 99%

“…Our review revealed that there are short- and long-term effects of low calcium dialysate on aortic stiffness. Acute effects appear to be reversible and related to changes in vascular tone from transient variations in calcium flux 41, 42, 43, 44, 45. Long-term effects, however, may be due to structural changes in the vascular wall associated with changes in bone turnover and regression of vascular calcification 41, 42, 46…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease

Rodriguez

Hae

Spence

et al. 2019

Kidney International Reports

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Introduction Increased carotid-femoral pulse wave velocity (cf-PWV) in end-stage renal disease (ESRD) indicates enhanced aortic stiffness and mortality risk. We conducted a systematic review and meta-analysis of nonpharmacologic interventions in adults with ESRD to determine their effects on cf-PWV, systolic blood pressure (SBP), and intervention-associated adverse events. Methods MEDLINE, EMBASE, and EBM databases were searched. Study screening, selection, data collection, and methodological quality assessments were performed by 2 independent reviewers. Pooled-effect estimates from mean differences and 95% confidence intervals (CIs) were calculated using random effect models. Results A total of 2166 subjects with ESRD from 33 studies (17 randomized; 16 nonrandomized) were included. Four intervention-comparator pairs were meta-analyzed. Quality of evidence ranged from very low to moderate. Kidney transplantation decreased cf-PWV (−0.70 m/s; CI: –1.3 to −0.11; P = 0.02) and SBP (−8.3 mm Hg; CI: −13.2 to −3.3; P < 0.001) over pretransplantation. In randomized trials, control of fluid overload by bio-impedance reduced cf-PWV (−1.90 m/s; CI: −3.3 to −0.5); P = 0.02) and SBP (−4.3 mm Hg; CI: −7.7 to −0.93); P = 0.01) compared with clinical assessment alone. Cross-sectional studies also demonstrated significantly lower cf-PWV and SBP in normovolemia compared with hypervolemia ( P ≤ 0.01). Low calcium dialysate decreased cf-PWV (−1.70 m/s; CI: −2.4 to −1.0; P < 0.00001) without affecting SBP (−1.6 mm Hg; CI: −8.9 to 5.8; P = 0.61). Intradialytic exercise compared with no exercise reduced cf-PWV (−1.13 m/s; CI: −2.2 to −0.03; P = 0.04), but not SBP (+0.5 mm Hg; CI: −9.5 to 10.4); P = 0.93). Conclusions Several nonpharmacologic interventions effectively decrease aortic stiffness in ESRD. The impact of these interventions on cardiovascular outcomes and mortality risk reduction in ESRD requires further study.

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Section: Discussionmentioning

confidence: 64%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease

Rodriguez

Hae

Spence

et al. 2019

Kidney International Reports

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“…Long-term use of HCD with a Ca 2+ ion concentration of 1.5 or 1.75 mmol/L promotes a positive Ca 2+ balance; however, long-term use of HCD increases the risk of vascular calcification in patients 8 , 10 . Studies have suggested that long-term use of dialysate containing 1.25 mmol/L Ca 2+ can effectively reduce the risk of cardiovascular calcification in MHD patients 11 – 13 , but it may also increase the risk of hypotension, muscle twitching, arrhythmias, and even sudden cardiac death in patients during dialysis 14 – 16 .…”

Section: Discussionmentioning

confidence: 99%

Safety of Low-calcium Dialysate and its Effects on Coronary Artery Calcification in Patients Undergoing Maintenance Hemodialysis

Yang

Gan

et al. 2018

Sci Rep

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To determine the safety of low-calcium-dialysate in patients undergoing maintenance hemodialysis (MHD) and its effects on coronary artery calcification (CAC) and analyze clinical risk factors for CAC. A total of 174 MHD patients were recruited and randomly divided into two groups: high-calcium dialysate (HCD, 1.5 mmol/L Ca2+) and low-calcium dialysate (LCD, 1.25 mmol/L Ca2+). Changes in CAC score (CACS) and cardiac function were evaluated using spiral computed tomography and echocardiography, respectively. Clinical and laboratory parameters were measured. Intra-dialysis adverse reactions were recorded and compared between the two groups. CACS was significantly lower in the LCD group than in the HCD group by the end of the study. Cardiac E/Amax was significantly higher in the LCD group than in the HCD group by the end of the study. There was no significant difference in the frequency of any intra-dialysis adverse reactions between the two groups during the study. LCD is helpful in maintaining cardiac diastolic function and postponing CAC progression. LCD does not increase intra-dialysis adverse reactions. Age may be the most important factor impacting CAC in MHD patients.

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Chronic Kidney Disease‐Mineral and Bone Disorder

Palmer

Strippoli

Craig

et al. 2022

Evidence‐Based Nephrology

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Low versus high dialysate calcium concentration in alternate night nocturnal hemodialysis: A randomized controlled trial

Cited by 6 publications

References 34 publications

A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease

A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease

Safety of Low-calcium Dialysate and its Effects on Coronary Artery Calcification in Patients Undergoing Maintenance Hemodialysis

Chronic Kidney Disease‐Mineral and Bone Disorder

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