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Abstract: PO0388

Citric Acid-Containing Dialysate (CD) Attenuates Vascular Calcification in Hemodialysis Patients (HD)

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Akiyama, Kenichi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Hanafusa, Norio, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Miyabe, Yoei, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Karasawa, Kazunori, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Moriyama, Takahito, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Tsuchiya, Ken, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

The main causes of death in patients with CKD, especially in HD, are heart failure, cardiovascular, and cerebrovascular disease, which are due to a high degree of systemic vascular calcification. Progression of aortic calcification, simply evaluated by chest radiography, was reported to be significantly associated with overall and cardiovascular mortality in HD. Recently, it was reported that the use of CD reduced blood calciprotein particles (CPPs) associated with arteriosclerosis and inflammation in HD. Therefore, we investigated the effect of using CD on blood CPPs and vascular calcification in HD in a retrospective observational study.


The subjects were 262 HD who were visiting the Joban Hospital in Japan. These patients were divided into two groups, those who continued to use acetate-containing dialysate (AD) or switched to CD from October 2017. A one-year retrospective observational study was conducted on the association with blood, laboratory test values, and AoACS (aortic arch calcification score) evaluated by chest X-ray. At baseline, patients with AoACS>50%, bisphosphonate, and warfarin use were excluded. Univariate, multivariate, subgroup analyses were used for statistical analysis. The main outcome was the presence or absence of AoACS exacerbation of 5% or more in one year.


A total of 115 patients with AD and 102 patients with CD matched to the criteria were included. As a result, the use of CD (HR 0.53, [95% confidence interval (CI) 0.30-0.92], P = 0.026), ALP (HR 0.97, 95 %CI 0.94-0.99, P = 0.013), and AoACS (HR 1.36, 95% CI 1.15-1.63], P = 0.0004) were significantly associated with an exacerbation of AoACS. Subgroup analyses showed the characteristics of patients who benefit from using CD are those older than 75 years old, those with non-diabetes as the underlying disease, low nPCR(normalized protein catabolic rate), high blood CRP, and not severe calcification. In other words, patients with MIA syndrome can benefit from the use of CD.


Among patients with mild to moderate vascular calcification, HD with CD had a significantly reduced progression of AoACS compared with AD. The results indicate that the dialysis method using CD in HD may be a useful therapeutic method for suppressing vascular calcification.


  • Government Support - Non-U.S.