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High-calcium dialysate: a factor associated with inflammation, malnutrition and mortality in non-diabetic maintenance haemodialysis patients.
Nephrology (Carlton). 2010 Apr; 15(3):313-20.N

Abstract

AIM

Chronic inflammation, which is common in dialysis patients, often causes malnutrition and even protein-energy wasting. However, the association of high-calcium dialysate with malnutrition and/or inflammation in non-diabetic maintenance haemodialysis patients remains unclear. This study investigated the possible adverse effects of high-calcium dialysate and mortality in this population.

METHODS

A total of 717 non-diabetic haemodialysis patients participated in this 2 year prospective study. The subjects were categorized into three subgroups based on whether dialysate calcium concentrations were high (3.5 mEq/L), standard (3.0 mEq/L) or low (2.5 mEq/L). Demographic, haematological, nutritional and inflammatory markers, biochemical and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup.

RESULTS

Patients with high-calcium dialysate (n = 82) had a higher incidence of malnutrition and inflammation (61.0% vs 44.1% and 43.9%, respectively) than those with standard- and low-calcium dialysate (n = 528 and 107). Backward stepwise multiple regression analysis revealed that high-calcium dialysate was negatively correlated with nutritional index, serum albumin levels, but positively associated with the inflammatory marker of serum ferritin levels. At the end of the 2 year follow up, 45 patients had died. Cox multivariate analysis demonstrated that high-calcium dialysate was a significant associated factor (relative risk 2.765; 95% confidence interval 1.429-5.352) for 2 year all-cause mortality in these patients.

CONCLUSION

The analytical results indicate that high-calcium dialysate is associated with malnutrition and inflammation as well as 2 year mortality in non-diabetic maintenance haemodialysis patients and the findings suggest that this population, even those with optimal mineral balance, should avoid high-calcium dialysate.

Authors+Show Affiliations

Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, 199 Tung-Hwa North Road, Taipei 100, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

20470300

Citation

Hsu, Ching-Wei, et al. "High-calcium Dialysate: a Factor Associated With Inflammation, Malnutrition and Mortality in Non-diabetic Maintenance Haemodialysis Patients." Nephrology (Carlton, Vic.), vol. 15, no. 3, 2010, pp. 313-20.
Hsu CW, Lin JL, Lin-Tan DT, et al. High-calcium dialysate: a factor associated with inflammation, malnutrition and mortality in non-diabetic maintenance haemodialysis patients. Nephrology (Carlton). 2010;15(3):313-20.
Hsu, C. W., Lin, J. L., Lin-Tan, D. T., Yen, T. H., Chen, K. H., Huang, W. H., Ho, T. C., & Huang, Y. L. (2010). High-calcium dialysate: a factor associated with inflammation, malnutrition and mortality in non-diabetic maintenance haemodialysis patients. Nephrology (Carlton, Vic.), 15(3), 313-20. https://doi.org/10.1111/j.1440-1797.2009.01202.x
Hsu CW, et al. High-calcium Dialysate: a Factor Associated With Inflammation, Malnutrition and Mortality in Non-diabetic Maintenance Haemodialysis Patients. Nephrology (Carlton). 2010;15(3):313-20. PubMed PMID: 20470300.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-calcium dialysate: a factor associated with inflammation, malnutrition and mortality in non-diabetic maintenance haemodialysis patients. AU - Hsu,Ching-Wei, AU - Lin,Ja-Liang, AU - Lin-Tan,Dan-Tzu, AU - Yen,Tzung-Hai, AU - Chen,Kuan-Hsing, AU - Huang,Wen-Hung, AU - Ho,Tai-Chin, AU - Huang,Yen-Lin, PY - 2010/5/18/entrez PY - 2010/5/18/pubmed PY - 2010/8/25/medline SP - 313 EP - 20 JF - Nephrology (Carlton, Vic.) JO - Nephrology (Carlton) VL - 15 IS - 3 N2 - AIM: Chronic inflammation, which is common in dialysis patients, often causes malnutrition and even protein-energy wasting. However, the association of high-calcium dialysate with malnutrition and/or inflammation in non-diabetic maintenance haemodialysis patients remains unclear. This study investigated the possible adverse effects of high-calcium dialysate and mortality in this population. METHODS: A total of 717 non-diabetic haemodialysis patients participated in this 2 year prospective study. The subjects were categorized into three subgroups based on whether dialysate calcium concentrations were high (3.5 mEq/L), standard (3.0 mEq/L) or low (2.5 mEq/L). Demographic, haematological, nutritional and inflammatory markers, biochemical and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup. RESULTS: Patients with high-calcium dialysate (n = 82) had a higher incidence of malnutrition and inflammation (61.0% vs 44.1% and 43.9%, respectively) than those with standard- and low-calcium dialysate (n = 528 and 107). Backward stepwise multiple regression analysis revealed that high-calcium dialysate was negatively correlated with nutritional index, serum albumin levels, but positively associated with the inflammatory marker of serum ferritin levels. At the end of the 2 year follow up, 45 patients had died. Cox multivariate analysis demonstrated that high-calcium dialysate was a significant associated factor (relative risk 2.765; 95% confidence interval 1.429-5.352) for 2 year all-cause mortality in these patients. CONCLUSION: The analytical results indicate that high-calcium dialysate is associated with malnutrition and inflammation as well as 2 year mortality in non-diabetic maintenance haemodialysis patients and the findings suggest that this population, even those with optimal mineral balance, should avoid high-calcium dialysate. SN - 1440-1797 UR - https://www.unboundmedicine.com/medline/citation/20470300/High_calcium_dialysate:_a_factor_associated_with_inflammation_malnutrition_and_mortality_in_non_diabetic_maintenance_haemodialysis_patients_ L2 - https://doi.org/10.1111/j.1440-1797.2009.01202.x DB - PRIME DP - Unbound Medicine ER -