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

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...

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Bibliographic Details
Published in:Clinical and experimental nephrology 2024-06, Vol.28 (6), p.557-570
Main Authors: Kamei, Keita, Yamada, Shunsuke, Hashimoto, Koji, Konta, Tsuneo, Hamano, Takayuki, Fukagawa, Masafumi
Format: Article
Language:English
Subjects:
Calcification
Calcification (ectopic)
Calcium - blood
Cardiovascular diseases
Cardiovascular Diseases - mortality
Cardiovascular Diseases - prevention & control
Clinical trials
Coronary artery
Death
Dialysate
Hemodialysis
Hemodialysis Solutions - adverse effects
Hemodialysis Solutions - chemistry
Humans
Medicine
Medicine & Public Health
Meta-analysis
Middle Aged
Nephrology
Original Article
Parathyroid hormone
Parathyroid Hormone - blood
Randomized Controlled Trials as Topic
Renal Dialysis - adverse effects
Structure-function relationships
Systematic review
Treatment Outcome
Urology
Vascular Calcification - diagnostic imaging
Vascular Calcification - prevention & control
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Summary: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.
ISSN:1342-1751
1437-7799
DOI:10.1007/s10157-024-02460-3