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Abstract: PO1141

Serum-to-Dialysate Calcium Gradient and Its Association with Mortality in Incident Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kimura, Hiroshi, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Wenziger, Cachet, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

A high serum-to-dialysate calcium gradient at start of hemodialysis leads to rapid lowering of serum calcium and was associated with higher risk of witnessed cardiac arrests. However, the association of serum-to-dialysate calcium gradient with mortality remains unclear. The objective of this study was to evaluate the serum-to-dialysate calcium gradient associated with a greater risk of adverse events in incident hemodialysis patients.

Methods

We retrospectively examined 96,339 in-center hemodialysis patients who initiated dialysis treatment between January 1, 2007, and December 31, 2011 in a large United States dialysis organization. Cox proportional hazards model was used to assess the multivariable association between serum-to-dialysate calcium gradient and patient survival.

Results

Higher serum-to-dialysate calcium gradient was associated with older age, higher proportion of hypertension, lower blood pressure in post dialysis, and worse nutritional indices. Adjusting for patients differences, there was a dose-response relationship between higher serum-to-dialysate calcium gradient and greater risk of all-cause mortality [adjusted hazard ratios: 1.00 (95% confidence interval [CI]: 0.96–1.04), 1.02 (95% CI: 0.97–1.06), and 1.09 (95% CI: 1.05–1.15) for subjects in the second, third, and fourth quartiles (reference: first quartile group)]. Similar trends were observed for cardiovascular and sudden cardiac mortalities.

Conclusion

Higher serum-to-dialysate calcium gradient is independently associated with greater risk of all-cause, cardiovascular, and sudden cardiac mortalities in hemodialysis patients.