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Abstract: PO1176

Effect of Citrasate Dialysate on Intact Parathyroid Hormone (iPTH) in Prevalent Hemodialysis (HD) Patients: A Matched Retrospective Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Zhou, Meijiao, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Ficociello, Linda, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Anger, Michael S., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

Citrate-acidified dialysate (CAD) has anti-coagulation properties compared to acetate-acidified dialysate (AAD), due to its binding of calcium. PTH regulates the calcium concentration through its actions on bone and kidney. The objective of this study is to assess any long-term changes in iPTH levels when patients (pts) are switched from AAD to CAD.

Methods

A retrospective cohort study of 3 clinics converting from AAD to CAD during 2009 to 2011 matched to 12 geographically proximate AAD clinics, on the same month as CAD conversion. Clinics were selected before year of 2013, so that the follow-up did not include time when the management of mineral bone disease changed at large dialysis organizations (LDOs). In-center HD pts included in the analysis received HD treatment for at least 6 months before (baseline, BL) and 6 months after (follow up, FU) CAD conversion. BL and 6-month FU average values of clinical measures were compared within and between CAD and AAD clinics. Measures included pre-dialysis iPTH and serum calcium (sCa), prescribed (Rx) dialysate calcium (dCa), Rx calcium-based phosphate binders (Ca-based PB), Cinacalcet and IV Vitamin D (VitD).

Results

Changes in iPTH and sCa were not significantly different from BL to FU between CAD and AAD clinics (Table). Mean iPTH decreased by 17 pg/mL (4.1%, p=0.49) in CAD clinics and increased by 13 pg/mL (3.8%, p=0.13) in AAD clinics. However, Rx dCa increased in CAD clinics, but not in AAD clinics. Increases of Ca-based PB and Cinacalcet prescriptions were greater in AAD clinics. No significant differences were observed in changes of VitD over time between CAD and AAD clinics.

Conclusion

Similar trends in iPTH and sCa were observed in clinics switched from AAD to CAD and geographically-matched clinics with continuous use of AAD.

 CAD clinics (142 pts)AAD clinics (671 pts)P (CAD vs AAD clinics) +
MeasuresBLFUΔ (FU- BL)BLFUΔ (FU- BL)
iPTH, pg/mL411394-17338351130.24
sCa, mg/dL8.939.000.079.039.080.05*0.61
dCa, mEq/L2.332.520.19*2.422.430.01<.0001
Ca-based PB, %20.4%27.5%7.1%*27.7%46.4%18.7%*0.01
Cinacalcet, %17.6%17.6%011.0%16.5%5.5%*0.01
VitD, %86.6%93.0%6.4%*83.0%87.6%4.6%*0.26

*p<0.05 from paired t or McNemar’s test +2 sample t test and repeated measures logistic regression for continuous and categorical variables

Funding

  • Commercial Support