Abstract: TH-PO1036

Intradialytic Change in Serum Calcium Concentration, but Not Dialysate Calcium Concentration, Is Associated with Cardiovascular Events in Hemodialysis Patients

Session Information

Category: Mineral Disease

  • 1201 Mineral Disease: Ca/Mg/PO4

Authors

  • Tagawa, Miho, Nara Medical University, Nara, Japan
  • Hamano, Takayuki, Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Sueta, Shinichi, Kyoto University, Kyoto, Japan
  • Ogata, Satoshi, Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Saito, Yoshihiko, Nara Medical University, Nara, Japan
Background

Association of dialysate calcium (Ca) concentration and cardiovascular (CV) events has been studied but intradialytic change in serum Ca concentration has not been studied in detail.

Methods

This was a longitudinal study based on the Japan Renal Data Registry from 2008 to 2009. Predictor variable was deltaCa (postdialysis - predialysis serum Ca concentration). Outcome variable was CV events during 1-year observation period. Statistical analyses were performed using multivariate logistic regression or Cox regression model, adjusted for potential confounders.

Results

Among 301,649 patients on the database, data for 44,700 patients were available after excluding missing data. There were 844, 1,450, and 1,815 events of myocardial infarction (MI), ischemic stroke, and CV death, respectively. Delta Ca was associated with higher incidence of MI and lower incidence of CV death (Table). Additional adjustment for dialysate Ca yielded similar results. Delta Ca was not associated with ischemic stroke. Delta Ca was associated with MI especially among diabetics and patients with low PTH (Figure).

Conclusion

Intradialytic increase in serum Ca concentration was associated with higher incidence of MI and lower incidence of CV death and it was not mediated through dialysate Ca concentration. It is suggested that not only predialysis but also postdialysis serum Ca concentration should be evaluated carefully and both large increase and decrease in intradialytic serum Ca concentration should be avoided not to increase MI and CV death, respectively.

 MI (OR)CV death (HR)
Intradialytic change in serum Ca concentration (per mg/dL)1.11 (1.02-1.20)0.83 (0.79-0.88)