Citric-acid dialysate improves the calcification propensity of hemodialysis patients: A multicenter prospective randomized cross-over trial

Autoři: Karlien J. ter Meulen aff001;  Marijke J. E. Dekker aff001;  Andreas Pasch aff003;  Natascha J. H. Broers aff001;  Frank M. van der Sande aff001;  Jeroen B. van der Net aff001;  Constantijn J. A. M. Konings aff002;  Isabelle M. Gsponer aff003;  Matthias D. N. Bachtler aff003;  Adelheid Gauly aff004;  Bernard Canaud aff004;  Jeroen P. Kooman aff001
Působiště autorů: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, the Netherlands aff001;  Department of Internal Medicine, Division of Nephrology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands aff002;  Calciscon AG, Nidau, Switzerland aff003;  Fresenius Medical Care, Bad Homburg, Germany aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



The concentration of dialysate calcium (dCa) has been suggested to affect vascular calcification, but evidence is scarce. Calcification propensity reflects the intrinsic capacity of serum to prevent calcium and phosphate to precipitate.

The use of citric-acid dialysate may have a beneficial effect on the calcification propensity due to the chelating effect on calcium and magnesium. The aim of this study was to compare the intradialytic and short-term effects of haemodialysis with either standard acetic-acid dialysate with dCa1.50 (A1.5) or dCa1.25 (A1.25), as well as citric-acid dialysate with dCa1.50 (C1.5) in bicarbonate dialysis on the calcification propensity of serum.


Chronic stable hemodialysis patients were included. This multicenter randomized cross-over study consisted out of a baseline week (A1.5), followed by the randomized sequence of A1.25 or C1.5 for one week after which the alternate treatment was provided after a washout week with A1.5. Calcification propensity of serum was assessed by time-resolved nephelometry where the T50 reflects the transition time between formation of primary and secondary calciprotein particles.


Eighteen patients (median age 70 years) completed the study. Intradialytic change in T50 was increased with C1.5 (121 [90–152]min) compared to A1.25 (83 [43–108]min, p<0.001) and A1.5 (66 [18–102]min, p<0.001). During the treatment week, predialysis T50 increased significantly from the first to the third session with C1.5 (271 [234–291] to 280 [262–339]min, p = 0.002) and with A1.25 (274 [213–308] to 307 [256–337]min, p<0.001), but not with A1.5 (284 [235–346] to 300 [247–335]min, p = 0.33).


Calcification propensity, as measured by the change in T50, improved significantly during treatment in C1.5 compared to A1.25 and A1.5. Long-term studies are needed to investigate the effects of different dialysate compositions concentrations on vascular calcification and bone mineral disorders.

Klíčová slova:

Calcification – Cardiovascular diseases – Hemodynamics – Medical dialysis – Phosphates – Renal failure – Statistical data – Bicarbonates


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2019 Číslo 12
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