The impact of low and high dialysate calcium concentrations on cardiovascular disease and death in patients undergoing maintenance hemodialysis: a systematic review and meta-analysis
- 24.02.2024
- Original article
Erschienen in:
- Verfasst von
- Keita Kamei
- Shunsuke Yamada
- Koji Hashimoto
- Tsuneo Konta
- Takayuki Hamano
- Masafumi Fukagawa
- Erschienen in
- Clinical and Experimental Nephrology | Ausgabe 6/2024
Abstract
Background
The optimal dialysate calcium (Ca) concentration for patients undergoing hemodialysis remains inconclusive, particularly concerning cardiovascular protection.
Methods
We conducted a systematic review of 19 randomized controlled trials (RCTs) and a meta-analysis of eight RCTs to determine the optimal dialysate Ca concentration for cardiovascular protection. We compared outcomes in patients receiving maintenance hemodialysis treated with either a low-Ca dialysate (LCD) (1.125 or 1.25 mmol/L) or a high-Ca dialysate (HCD) (1.5 or 1.75 mmol/L). The outcomes were coronary artery calcification score (CACS), all-cause and cardiovascular death, cardiovascular function and structure, and serum biochemical parameters.
Results
There was no significant difference between LCD and HCD concerning CACS (standardized mean difference [SMD] = −0.16, 95% confidence interval [CI]: [−0.38, 0.07]), the risk of all-cause death, and cardiovascular death in patients treated with chronic maintenance hemodialysis. Conversely, LCD was associated with a significantly lower intima-media thickness (SMD = −0.49, 95% CI [−0.94, −0.05]) and pulse wave velocity than HCD (SMD = −0.86, 95% CI [−1.21, −0.51]). Furthermore, LCD significantly decreased serum Ca levels (mean difference [MD] = 0.52 mg/dL, 95% CI [0.19, 0.85]) and increased serum parathyroid hormone levels (MD = 44.8 pg/mL, 95% CI [16.2, 73.3]) compared with HCD. Notably, most RCTs examined in our analysis did not include patients receiving calcimimetics.
Conclusions
Our meta-analysis showed no significant differences in cardiovascular calcification and death between LCD and HCD and revealed a paucity of RCTs on dialysate Ca concentrations, including those involving patients on calcimimetics, indicating the urgent need for further studies.
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- Titel
- The impact of low and high dialysate calcium concentrations on cardiovascular disease and death in patients undergoing maintenance hemodialysis: a systematic review and meta-analysis
- Verfasst von
-
Keita Kamei
Shunsuke Yamada
Koji Hashimoto
Tsuneo Konta
Takayuki Hamano
Masafumi Fukagawa
- Publikationsdatum
- 24.02.2024
- Verlag
- Springer Nature Singapore
- Erschienen in
-
Clinical and Experimental Nephrology / Ausgabe 6/2024
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799 - DOI
- https://doi.org/10.1007/s10157-024-02460-3
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