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

PLoS One. 2016 Apr 11;11(4):e0151508. doi: 10.1371/journal.pone.0151508. eCollection 2016.

Abstract

Background: Calciprotein particles (CPPs) may play an important role in the calcification process. The calcification propensity of serum (T50) is highly predictive of all-cause mortality in chronic kidney disease patients. Whether T50 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 (T50 test), by time-resolved nephelometry.

Results: We included 64 patients, mean convective volume was 21.7L (SD 3.3L). In the pooled analysis, T50 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 T50 was 26.29% for HD and 21.97% for HDF patients (P = 0.61 (HD vs. HDF)). The delta values (Δ) of calcium, phosphate and serum albumin were equal in both groups. Baseline T50 was negatively correlated with phosphate, and positively correlated with serum magnesium and fetuin-A. The ΔT50 was mostly influenced by Δ phosphate (r = -0.342; P = 0.002 HD and r = -0.396; P<0.001 HDF) in both groups.

Conclusions: HD and HDF patients present with same baseline T50 calcification propensity values pre-dialysis. Calcification propensity is significantly improved during both HD and HDF sessions without significant differences between both modalities.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Calcification, Physiologic / physiology*
  • Cross-Sectional Studies
  • Female
  • Hemodiafiltration / methods*
  • Humans
  • Kidney Failure, Chronic / blood*
  • Kidney Failure, Chronic / pathology
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Phosphates / blood*
  • Renal Dialysis / methods*
  • alpha-2-HS-Glycoprotein / analysis*

Substances

  • AHSG protein, human
  • Phosphates
  • alpha-2-HS-Glycoprotein

Grant support

This study was supported by an unrestricted grant from Fresenius MC, Bad Homburg, Germany who provided support in the form of salaries for author BC, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Calciscon AG provided support in the form of salaries for authors AP, M. Dionisi and MM, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.