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NDT Advance Access published online on August 4, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp351
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© The Author [2009].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Effects of acute variation of dialysate calcium concentrations on arterial stiffness and aortic pressure waveform

Amélie LeBeouf1, Fabrice Mac-Way1, Mihai Silviu Utescu1, Nadia Chbinou1, Pierre Douville2, Simon Desmeules1 and Mohsen Agharazii1

1 Division of Nephrology 2 Division of Medical Biochemistry, Research Center of CHUQ, L’Hôtel Dieu de Québec Hospital and Faculty of Medicine, Laval University, Quebec, QC, Canada

Correspondence and offprint requests to: Mohsen Agharazii; E-mail: mohsen.agharazii{at}crhdq.ulaval.ca



  Abstract

Background. Abnormal mineral metabolism in chronic kidney disease plays a critical role in vascular calcification and arterial stiffness. The impact of presently used dialysis calcium concentration (DCa) on arterial stiffness and aortic pressure waveform has never been studied. The aim of the present study is to evaluate, in haemodialysis (HD) patients, the impact of acute modification of DCa on arterial stiffness and central pulse wave profile (cPWP).

Method. A randomized Latin square cross-over study was used to evaluate the three different concentrations of DCa (1.00, 1.25 and 1.50 mmol/L) during the second HD of the week for 3 consecutive weeks. Subjects returned to their baseline DCa for the following two treatments, allowing for a 7-day washout period between each experimental HD. cPWP, carotido-radial (c-r) and carotido-femoral (c-f) pulse wave velocities (PWV), plasma level of ionized calcium (iCa) and intact parathyroid hormone (PTH) were measured prior to and immediately after each experimental HD session. Data were analysed by the general linear model for repeated measures and by the general linear mixed model.

Results. Eighteen patients with a mean age of 48.9 ± 18 years and a median duration of HD of 8.7 months (range 1–87 months) completed the study. In post-HD, iCa decreased with DCa of 1.00 mmol/L (–0.14 ± 0.04 mmol/L, P < 0.001), increased with a DCa of 1.50 mmol/L (0.10 ± 0.06 mmol/L, P < 0.001) but did not change with a DCa of 1.25 mmol/L. Tests of within-subject contrast showed a linear relationship between higher DCa and a higher post-HD {Delta}c-f PWV, {Delta}c-r PWV and {Delta}mean BP (P < 0.001, P = 0.008 and P = 0.002, respectively). Heart rate-adjusted central augmentation index (AIx) decreased significantly after HD, but was not related to DCa. The timing of wave refection (Tr) occurred earlier after dialysis resulting in a linear relationship between higher DCa and post-HD earlier Tr (P < 0.044). In a multivariate linear-mixed model for repeated measures, the percentage increase in c-f PWV and c-r PWV was significantly associated with the increasing level of iCa, whereas the increasing level of {Delta}MBP was not significant. In contrast, the percentage decrease in Tr (earlier wave reflection) was determined by higher {Delta}MBP and higher ultrafiltration, whereas the relative change in AIx was inversely determined by the variation in the heart rate and directly by {Delta}MBP.

Conclusion. We conclude that Dca and acute changes in the serum iCa concentration, even within physiological range, are associated with detectable changes of arterial stiffness and cPWP. Long-term studies are necessary to evaluate the long-term effects of DCa modulation on arterial stiffness.

Keywords: arterial stiffness; calcium; haemodialysis; pulse wave profile; pulse wave velocity

Received for publication: 17. 3.09
Accepted in revised form: 25. 6.09


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