Ken-Ichi Akiyama1, Takahito Moriyama2,3, Norio Hanafusa4, Yutaka Miura5, Momoko Seki1, Yusuke Ushio1, Kentaro Kawasoe1, Yoei Miyabe1, Kazunori Karasawa1, Hidekazu Sugiura6, Keiko Uchida1, Masayuki Okazaki7, Mizuki Komatsu7, Hiroshi Kawaguchi7, Makoto Kuro-O5, Kosaku Nitta1, Junichi Hoshino1. 1. Department of Nephrology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-ku, Tokyo, 1628666, Japan. 2. Department of Nephrology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-ku, Tokyo, 1628666, Japan. takamori@twmu.ac.jp. 3. Department of Nephrology, Tokyo Medical University, 6-7-1, Nishishinjyuku, Shinjuku-ku, Tokyo, 1600023, Japan. takamori@twmu.ac.jp. 4. Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan. 5. Division of Anti-Aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Shimotsuke, Japan. 6. Department of Nephrology, Division of Medicine, Saiseikai Kurihashi Hospital, Kuki, Saitama, Japan. 7. Department of Nephrology, Joban Hospital, Iwaki-city, Fukushima, Japan.
Abstract
BACKGROUND: Progression of aortic calcification is associated with all-cause and cardiovascular mortality in hemodialysis patients. Blood calciprotein particle (CPP) levels are associated with coronary artery calcification and were reported to be inhibited when using citric acid-based bicarbonate dialysate (CD). Therefore, this study aimed to examine the effect of CD on the progression of the aortic arch calcification score (AoACS) and blood CPP levels in hemodialysis patients. METHODS: A 12-month retrospective observational study of 262 hemodialysis patients was conducted. AoACS was evaluated by calculating the number of calcifications in 16 segments of the aortic arch on chest X-ray (minimum score is 0; maximum score is 16 points). The patients were divided into the following groups according to their baseline AoACS: grade 0, AoACS = 0 points; grade 1, AoACS 1-4 points; grade 2, AoACS 5-8 points; grade 3, AoACS 9 points or higher. Patients on bisphosphonates or warfarin or with AoACS grade 3 were excluded. Progression, defined as ΔAoACS (12-month score - baseline score) > 0 points, was compared between the CD and acetic acid-based bicarbonate dialysate (AD) groups before and after adjusting the background using propensity score matching. RESULTS: The AoACS progression rate was significantly lower in the CD group than in the AD group (before matching: P = 0.020, after matching: P = 0.002). Multivariate logistic regression analysis showed that CD was significantly associated with AoACS progression (odds ratio 0.52, 95% confidence interval 0.29‒0.92, P = 0.025). CONCLUSION: CD may slow the progression of vascular calcification in hemodialysis patients.
BACKGROUND: Progression of aortic calcification is associated with all-cause and cardiovascular mortality in hemodialysis patients. Blood calciprotein particle (CPP) levels are associated with coronary artery calcification and were reported to be inhibited when using citric acid-based bicarbonate dialysate (CD). Therefore, this study aimed to examine the effect of CD on the progression of the aortic arch calcification score (AoACS) and blood CPP levels in hemodialysis patients. METHODS: A 12-month retrospective observational study of 262 hemodialysis patients was conducted. AoACS was evaluated by calculating the number of calcifications in 16 segments of the aortic arch on chest X-ray (minimum score is 0; maximum score is 16 points). The patients were divided into the following groups according to their baseline AoACS: grade 0, AoACS = 0 points; grade 1, AoACS 1-4 points; grade 2, AoACS 5-8 points; grade 3, AoACS 9 points or higher. Patients on bisphosphonates or warfarin or with AoACS grade 3 were excluded. Progression, defined as ΔAoACS (12-month score - baseline score) > 0 points, was compared between the CD and acetic acid-based bicarbonate dialysate (AD) groups before and after adjusting the background using propensity score matching. RESULTS: The AoACS progression rate was significantly lower in the CD group than in the AD group (before matching: P = 0.020, after matching: P = 0.002). Multivariate logistic regression analysis showed that CD was significantly associated with AoACS progression (odds ratio 0.52, 95% confidence interval 0.29‒0.92, P = 0.025). CONCLUSION: CD may slow the progression of vascular calcification in hemodialysis patients.
Authors: Marlies Noordzij; Ellen M Cranenburg; Lyda F Engelsman; Marc M Hermans; Elisabeth W Boeschoten; Vincent M Brandenburg; Willem Jan W Bos; Jeroen P Kooman; Friedo W Dekker; Markus Ketteler; Leon J Schurgers; Raymond T Krediet; Johanna C Korevaar Journal: Nephrol Dial Transplant Date: 2010-09-29 Impact factor: 5.992
Authors: Edward R Smith; Martin L Ford; Laurie A Tomlinson; Chakravarthi Rajkumar; Lawrence P McMahon; Stephen G Holt Journal: Nephrol Dial Transplant Date: 2011-11-20 Impact factor: 5.992