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Kidney Week

Abstract: TH-PO294

Impact of Dialysate Calcium Concentration on Bone Metabolism in Relation to Different Calcimimetics

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hashiguchi, Jyunichiro, Nagasaki Renal Center, Nagasaki, Japan
  • Nishino, Tomoya, Nagasaki Daigaku Byoin, Nagasaki, Nagasaki, Japan
  • Funakoshi, Satoshi, Nagasaki Renal Center, Nagasaki, Japan
Background

In Japan, three types of calcimimetics are currently approved to treat secondary hyperparathyroidism. However, the specific impact of these drugs on bone metabolism remains unknown. Furthermore, limited research is available on the potential influence of different dialysate calcium concentrations used during hemodialysis on the bone-related effects of these calcimimetics. This study aimed to examine the influence of dialysate calcium concentration on bone metabolism associated with different calcimimetics.

Methods

Ninety patients undergoing hemodialysis with a dialysate containing either a calcium concentration of 2.75 mEq/mL or 2.5 mEq/mL and having secondary hyperparathyroidism with an intact parathyroid hormone (i-PTH) level ranging from 50–400 pg/mL were included in the study. These participants had been taking calcimimetics for more than a year. Six groups were established by combining two dialysate calcium concentrations and three types of calcimimetic preparations. Changes in bone mineral density were assessed over six months using the Dual-Energy X-ray Absorptiometry (DEXA) Imaging Protocol.

Results

In patients with a calcium concentration of 2.5 mEq/L dialysate, evocalcet and etelcalcetide resulted in an increase in bone mineral density by 4.4% and 1.3%, respectively. Conversely, upacicalcet showed a decrease in bone mineral content by 3.3%. Among patients receiving dialysate with a calcium concentration of 2.75 mEq/L, only upacicalcet resulted in a significant reduction of 2.3% in bone mineral density when comparing pre- and post-medication measurements. (Figure)

Conclusion

Calcimimetics exert significant effects on bone metabolism in addition to their ability to lower iPTH levels. However, this effect may vary depending on the concentration of calcium in the dialysate.