Impact of dialysate composition on the progression of coronary artery calcification in patients undergoing hemodialysis: A prospective, interventional study

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Abstract Title *

Impact of dialysate composition on the progression of coronary artery calcification in patients undergoing hemodialysis: A prospective, interventional study

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Co-author 1

Machiko Oka machiko.oka@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan *

Co-author 2

Takayasu Ohtake ohtake@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 3

Kunihiro Ishioka kunihiro.ishioka@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 4

Yasuhiro Mochida yasuhiromochida@gmail.com Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 5

Kyoko Maesato kyoko.maesato@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 6

Hidekazu Moriya hidekazu.moriya@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 7

Sumi Hidaka s_hidaka@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 8

Shuzo Kobayashi shuzo@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Calcium deposition in vascular walls following hemodialysis-induced acid–base cycling contributes to vascular calcification in hemodialysis patients. However, the influence of acidosis or acid–base cycling status on the progression of coronary artery calcification (CAC) in these patients is unclear. We aimed to compare the effects of two different dialysates on CAC progression to evaluate the relationship between dialysate composition and quantitatively-assessed CAC using multi-slice computed tomography (MSCT).

Methods

This prospective interventional study was conducted from August 2018 to November 2021 at Shonan Kamakura General Hospital and Shonan Fujisawa Tokushukai Hospital. We used two dialysates with different bicarbonate concentrations, calcium levels, and acids (Kindaly 3EⓇ and Carbostar PⓇ) to evaluate their effects on CAC progression. Kindaly 3EⓇ is an acetic acid dialysate with calcium and bicarbonate concentrations of 2.5 mEq/L and 25 mmol/L, respectively. Carbostar PⓇ is a citric acid dialysate with a dialysate calcium of 3.0 mEq/L and a bicarbonate concentration of 35 mmol/L.

The study was conducted as per the Declaration of Helsinki and approved by the Ethics Committee of Tokushukai Medical Group (TGE01018-008 22/05/2018; TGE-1018-024 29/11/2018). Informed consent was obtained from all participants.

Results

Fifty-three hemodialysis patients underwent MSCT, and 45 of these were subjected to follow-up MSCT at 6 and 12 months for CAC score (CACS) evaluation. Pre-hemodialysis bicarbonate levels and CACS changes over 6 months (ΔCACS) were significantly higher with Carbostar PⓇ group than in the Kindaly 3EⓇ group. Serum calcium and phosphorus levels showed no significant changes. Intact parathyroid hormone levels increased significantly; while bone alkaline phosphatase and tartrate-resistant acid phosphatase-5b significantly decreased after 6 months of using Carbostar PⓇ.

Conclusion

Pre-hemodialysis bicarbonate levels and changes in CACS over 6 months were significantly lower with the low-bicarbonate, acetic acid dialysate than with the citric-acid dialysate. This study offers valuable insights for determining the optimal dialysis approach for patients.

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