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Abstract: FR-PO445

Dialysis Initiation Improves Calcification Propensity

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ponte, Belen, University Hospital of Geneva, Geneva, Switzerland
  • Pasch, Andreas, Calciscon AG, Nidau, Switzerland
  • Martin, Pierre-Yves F., University Hospital of Geneva, Geneva, Switzerland
  • De Seigneux, Sophie M., University Hospital of Geneva, Geneva, Switzerland
Background

Cardiovascular morbidity and mortality is high in patients starting dialysis and could be related to modifications of calcification inducers and inhibitors by dialysis, promoting cardiovascular events. The impact of dialysis initiation on serum calcification propensity evolution and arterial stiffness is however not known. We therefore, prospectively determined the evolution of the T50-value and its main determinants, as well as pulse wave velocity (PWV) over the first three months of dialysis initiation.

Methods

We analyzed the evolution of T50, fetuin-A and phosphocalcic parameters before dialysis initation (M0), and monthly until month three (M3) of incident patients starting hemodialysis (HD) or peritoneal dialysis (PD) in two tertiary Swiss University Hospitals. Arterial stiffness was assessed by pulse tonometry at M0 and M3, and biological parameters were compared between M0 and M3 and before/after HD. Linear mixed models were used to assess parameter evolution over time taking into account repeated measures and other influencing variables.

Results

Forty-six patients on HD and 12 on PD were followed. Among them, 45 were male (78 %) with median age of 67 years (25th-75th: 54-77). T50 significantly increased between M0 and M3 from 183 (120-266) to 246 (175-330) minutes, p<0.001. Fetuin-A, calcium and magnesium also increased while phosphate decreased. Factors associated with T50 changes over time were fetuin-A, phosphate and magnesium (p<0.001). Fetuin-A changes were associated with inflammation-related factors (albumin, crp) but not phosphocalcic parameters. Arterial stiffness was not significantly modified over 3 months. PD and HD initiation showed similar trends.

Conclusion

Dialysis initiation significantly improves calcification propensity and fetuin-A levels. These modifications do not explain the high mortality related to dialysis initiation. The clinical relevance of using T50 values to initiate dialysis awaits further studies.

Funding

  • Government Support - Non-U.S.