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Abstract: TH-PO588

The Effect of Increasing Dialysate Magnesium on Calciprotein Particles, Inflammation, and Bone Markers in Subjects with ESKD: Post Hoc Analyses from a Randomized Controlled Trial

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Bressendorff, Iain Oshoj, Nordsjælland's Hospital, Hillerød, Denmark
  • Hansen, Ditte, Herlev and Gentofte Hospital, Herlev, Denmark
  • Pasch, Andreas, University Hospital Bern, Bern, Switzerland
  • Holt, Stephen G., The Royal Melbourne Hospital, Melbourne, New South Wales, Australia
  • Schou, Morten, Herlev and Gentofte Hospital, Herlev, Denmark
  • Brandi, Lisbet, Nordsjælland's Hospital, Hillerød, Denmark
  • Smith, Edward R., The Royal Melbourne Hospital, Melbourne, New South Wales, Australia
Background

The formation of fetuin-A-laden mineral-containing nanoaggregates, calciprotein particles (CPP), act as an important component of the humoral defenses against ectopic calcification. Magnesium (Mg) has been shown to delay the transition of amorphous calcium/phosphate-containing primary CPP to crystalline apatite-containing secondary CPP ex vivo, but the effects of increasing dialysate Mg on the endogenous CPP load is unknown.

Methods

Post-hoc analyses from a randomized double-blind parallel-group controlled clinical trial of 28 days treatment with high dialysate Mg of 2.0 mEq/L versus standard dialysate Mg of 1.0 mEq/L in 57 subjects undergoing maintenance hemodialysis for end-stage kidney disease. CPP particle load, markers of systemic inflammation and bone turnover were measured in serum at baseline and follow-up.

Results

After 28 days of treatment with high dialysate Mg, serum total CPP (–52%), primary CPP (–42%), and secondary CPP (–68%), were all lower in the high Mg group (p < 0.001), but were unchanged in the standard dialysate Mg group. Concentrations of tumor necrosis factor-alpha (–20%) and interleukin-6 (–22%) were also reduced with high dialysate Mg treatment (p < 0.01). With respect to effects on bone turnover markers, high dialysate Mg resulted in higher levels of bone-specific alkaline phosphatase (a marker of bone formation) (+17%) but lower levels of tartrate-resistant acid phosphatase 5b (a marker of bone resorption) (–33%) (p < 0.01). Inflammatory cytokines and bone turnover markers were unchanged in the standard dialysate Mg group over the same period. Correlation analyses between changes in the various parameters suggest that increasing serum Mg reduces CPP release from bone and thus lowers systemic inflammation related to CPP particle load.

Conclusion

Increasing dialysate Mg reduces CPP particle load and systemic inflammation, while also increasing markers of bone formation and decreasing markers of bone resorption.

Funding

  • Private Foundation Support