Abstract: SA-PO753

A Twelve Month Retrospective Analysis of Corrected Serum Calcium (CSC) and Parathyroid Hormone (iPTH) in Patients Hemodialyzed with Citrate Acidified Dialysate (CD)

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Ficociello, Linda H., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Anderson, Ludmila, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Balter, Paul, Renal Research Institute, New York, New York, United States
  • Topping, Alice, Renal Research Institute, New York, New York, United States
  • Mullon, Claudy, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

CD contains citric acid (citrate) as the acidifying agent. In the blood, citrate binds to calcium (Ca); however, citrate is quickly metabolized by the liver releasing and restoring Ca levels. The objective of this database analysis was to assess potential effects of CD on CSC and iPTH in chronic hemodialysis (HD) patients who converted from acetate acidified dialysate (AD) to CD.

Methods

HD patients with 3 mos. of AD treatment data (baseline [BL]) followed by 12 mos. of CD treatment data were analyzed. Mean pre-HD CSC and iPTH laboratory values for AD and CD treatment periods were compared by quarters (Q1-Q4) and overall. Subanalyses were carried out by iPTH ranges (<130, 130-600, >600 pg/ml) during BL. Changes in concomitant medications (Ca-based phosphate binders [CaPB], cinacalcet, in-center vitamin D [VitD]) were explored. Paired t-test, chi2, α=.05 were used.

Results

Non-significant changes in CSC were observed after the CD conversion. Increases in iPTH during Q1 leveled off during Q2-Q4, with the exception of the BL iPTH > 600 pg/ml group where a steady iPTH decrease occurred (BL: 1,095.4 vs. Q4: 905.1 pg/ml, p<.001) (Table). From BL to Q4, the proportion of patients treated with CaPB remained the same (18% vs. 22%), cinacalcet use increased from 22% to 31% (p=.01), and in-center VitD use from 81% to 88% (p<.001).

Conclusion

No changes in CSC, and clinically modest changes in iPTH, followed the conversion from AD to CD. Variability was observed according to the BL iPTH range. Limitations include the observational nature of the assessment and inability to account for wide-ranging clinical practices. Future analyses should incorporate ionized Ca.

iPTH (pg/ml)BL Q1Q2Q3Q4BL-Q4 Change
p-value
All Patients
n=483
Change from prior quarter
635.5667.1
+31.6
695.2
+28.1*
686.5
-8.7
639.1
-47.4*
0.9
BL iPTH < 130
n = 31
Change from prior quarter
77.3241.8
+164.5*
336.2
+94.4*
351.0
+14.9
364.5
+13.5
<.001
BL iPTH 130-600
n = 262
Change from prior quarter
368.0464.1
+96.1*
502.1
+38.0*
515.9
+13.8
478.8
-37.2*
<.001
BL iPTH > 600
n = 190
Change from prior quarter
1,095.41,016.4
-79.0*
1,020.1
+3.6
976.5
-43.6
905.1
-71.3*
<.001

* p-value < .05 for the change

Funding

  • Commercial Support