High-Flux Hemodialysis and High-Volume Hemodiafiltration Improve Serum Calcification Propensity

Marijke Dekker*, Andreas Pasch, Franciscus van der Sande, Constantijn Konings, Matthias Bachtler, Mauro Dionisi, Matthias Meier, Jeroen Kooman, Bernard Canaud

*Corresponding author for this work

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Abstract

Background Calciprotein particles (CPPs) may play an important role in the calcification process. The calcification propensity of serum (T-50) is highly predictive of all-cause mortality in chronic kidney disease patients. Whether T-50 is therapeutically improvable, by high-flux hemodialysis (HD) or hemodiafiltration (HDF), has not been studied yet. Methods We designed a cross-sectional single center study, and included stable prevalent in-center dialysis patients on HD or HDF. Patients were divided into two groups based on dialysis modality, were on a thrice-weekly schedule, had a dialysis vintage of > 3 months and vascular access providing a blood flow rate > 300 ml/min. Calcification propensity of serum was measured by the time of transformation from primary to secondary CPP (T-50 test), by time-resolved nephelometry. Results We included 64 patients, mean convective volume was 21.7L (SD 3.3L). In the pooled analysis, T-50 levels increased in both the HD and HDF group with pre-and post-dialysis (mean (SD)) of 244(64) - 301(57) and 253(55) - 304(61) min respectively (P = 0.43(HD vs. HDF)). The mean increase in T-50 was 26.29% for HD and 21.97% for HDF patients (P = 0.61 (HD vs. HDF)). The delta values (.) of calcium, phosphate and serum albumin were equal in both groups. Baseline T-50 was negatively correlated with phosphate, and positively correlated with serum magnesium and fetuin-A. The Delta T-50 was mostly influenced by Delta phosphate (r = -0.342; P = 0.002 HD and r = -0.396; P
Original languageEnglish
Article numbere0151508
JournalPLOS ONE
Volume11
Issue number4
DOIs
Publication statusPublished - 11 Apr 2016

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