Acetate-free, citrate-acidified bicarbonate dialysis improves serum calcification propensity-a preliminary study

Nephrol Dial Transplant. 2018 Nov 1;33(11):2043-2051. doi: 10.1093/ndt/gfy134.


Background: A novel in vitro test (T50 test) assesses ex vivo serum calcification propensity and predicts mortality in chronic kidney disease and haemodialysis (HD) patients. For the latter, a time-dependent decline of T50 was shown to relate to mortality. Here we assessed whether a 3-month switch to acetate-free, citrate-acidified, standard bicarbonate HD (CiaHD) sustainably improves calcification propensity.

Methods: T50 values were assessed in paired midweek pre-dialysis sera collected before and 3 months after CiaHD in 78 prevalent European HD patients. In all, 44 were then switched back to acetate. Partial correlation was used to study associations of changing T50 and changing covariates. Linear mixed effect models were built to assess the association of CiaHD and covariates with changing T50.

Results: A significant intra-individual increase of serum calcification resilience was found after 3 months on CiaHD (206 ± 56 to 242 ± 56 min; P < 0.001), but not after switching back to acetate (252 ± 63 to 243 ± 64 min; n = 44; P = 0.29). CiaHD, Δ serum phosphate and Δ albumin but not Δ ionized calcium and magnesium were the strongest determinants of changing T50. Beneath T50, only serum albumin but not phosphate changed significantly during 3 months of CiaHD.

Conclusion: CiaHD dialysis favourably affected calcification propensity as measured by the T50 test. Whether this treatment, beyond established phosphate-directed treatments, has the potential to sustainably tip the balance towards a more anti-calcific serum milieu needs to be further investigated.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bicarbonates / therapeutic use
  • Calcinosis / blood*
  • Citric Acid / therapeutic use
  • Female
  • Humans
  • Male
  • Middle Aged
  • Phosphates / blood
  • Prospective Studies
  • Renal Dialysis / methods*
  • Renal Insufficiency, Chronic / blood*
  • Renal Insufficiency, Chronic / mortality
  • Serum Albumin / analysis


  • Bicarbonates
  • Phosphates
  • Serum Albumin
  • Citric Acid