The effects of dialysate calcium prescription on mortality outcomes in incident patients on hemodialysis.

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY Clinical Kidney Journal Pub Date : 2024-10-04 eCollection Date: 2024-10-01 DOI:10.1093/ckj/sfae288

Karlien J Ter Meulen, Paola Carioni, Francesco Bellocchio, Frank M van der Sande, Heleen J Bouman, Stefano Stuard, Luca Neri, Jeroen P Kooman

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Abstract

Background: The appropriate prescription of dialysate calcium concentration for hemodialysis is debated. We investigated the association between dialysate calcium and all-cause, cardiovascular mortality and sudden cardiac death.

Methods: In this historical cohort study, we included adult incident hemodialysis patients who initiated dialysis between 1 January 2010 and 30 June 2017 who survived for at least 6 months (grace period). We evaluated the association between dialysate calcium 1.25 or 1.50 mmol/l and outcomes in the 2 years after the grace period, using multivariable Cox regression models. Moreover, we examined the association between the serum dialysate to calcium gradient and outcomes.

Results: We included 12 897 patients with dialysate calcium 1.25 mmol/l and 26 989 patients with dialysate calcium 1.50 mmol/l. The median age was 65 years, and 61% were male. The unadjusted risk of all-cause mortality was higher for dialysate calcium 1.50 mmol/l [hazard ratio (HR) 1.07, 95% confidence intervals (CI) 1.01-1.12]. However, in the fully adjusted model, no significant differences were noted (HR 1.05, 95% CI 0.99-1.12). Similar results were observed for the risk of cardiovascular mortality (HR 1.03, 95% CI 0.94-1.13). Adjusted risk of sudden cardiac death was lower for dialysate calcium 1.50 mmol/l (HR 0.81, 95% CI 0.67-0.97). Significant and positive associations with all outcomes were observed with larger serum-to-dialysate calcium gradients, primarily mediated by the serum calcium level.

Conclusions: In contrast to the unadjusted analysis that showed a higher risk for dialysate calcium of 1.50 mmol/l, after adjusting for confounders, there were no significant differences in the risk of all-cause and cardiovascular mortality between dialysate calcium concentrations of 1.50 and 1.25 mmol/l. After adjustment, a lower risk of sudden cardiac death was observed in patients with dialysate calcium 1.50 mmol/l. A higher serum-to-dialysate calcium gradient is associated with an increased risk for adverse outcomes.

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透析液钙处方对血液透析患者死亡率的影响。

背景：关于血液透析中透析液钙浓度的适当处方还存在争议。我们研究了透析液钙与全因死亡率、心血管死亡率和心脏性猝死之间的关系：在这项历史队列研究中，我们纳入了在 2010 年 1 月 1 日至 2017 年 6 月 30 日期间开始透析且存活至少 6 个月（宽限期）的成人事故血液透析患者。我们使用多变量 Cox 回归模型评估了透析液钙 1.25 或 1.50 mmol/l 与宽限期后 2 年的预后之间的关系。此外，我们还研究了血清透析液钙梯度与预后之间的关系：我们纳入了 12 897 名透析液钙为 1.25 mmol/l 的患者和 26 989 名透析液钙为 1.50 mmol/l 的患者。中位年龄为 65 岁，61% 为男性。未经调整的全因死亡风险在透析液钙为 1.50 mmol/l 时更高[危险比 (HR) 1.07，95% 置信区间 (CI) 1.01-1.12]。然而，在完全调整模型中，没有发现显著差异（HR 1.05，95% CI 0.99-1.12）。在心血管死亡风险方面也观察到类似的结果（HR 1.03，95% CI 0.94-1.13）。透析液钙为 1.50 mmol/l 时，调整后的心脏性猝死风险较低（HR 0.81，95% CI 0.67-0.97）。血清钙与透析液钙梯度越大，所有结果均呈显著正相关，主要由血清钙水平介导：未经调整的分析表明，透析液钙浓度为 1.50 mmol/l 时风险较高，而调整混杂因素后，透析液钙浓度为 1.50 mmol/l 和 1.25 mmol/l 之间的全因和心血管死亡风险无显著差异。经调整后发现，透析液钙浓度为 1.50 毫摩尔/升的患者发生心脏性猝死的风险较低。血清-透析液钙梯度越高，不良后果风险越高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Kidney Journal Medicine-Transplantation

CiteScore

6.70

自引率

10.90%

发文量

242

审稿时长

8 weeks

期刊介绍： About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.