Varying dialysate calcium dosage not tied to differences in all-cause, cardiovascular mortality

There are no significant differences in all-cause or cardiovascular mortality with the prescription of dialysate calcium 1.50 versus 1.25 mmol/L for patients undergoing hemodialysis, according to a study published online Oct. 4 in the Clinical Kidney Journal.

Karlien J. ter Meulen, from Maastricht University Medical Centre in the Netherlands, and colleagues investigated the association between dialysate calcium and all-cause, cardiovascular, and sudden cardiac death in hemodialysis patients. The analysis included 12,897 patients with dialysate calcium 1.25 mmol/L and 26,989 patients with dialysate calcium 1.50 mmol/L initiation.

The researchers found that the unadjusted risk for all-cause mortality was higher for dialysate calcium 1.50 mmol/L (hazard ratio [HR], 1.07). When fully adjusting for other confounders, there were no significant differences (HR, 1.05; 95% confidence interval [CI], 0.99 to 1.12).

Similar results were seen for cardiovascular mortality (HR, 1.03; 95% CI, 0.94 to 1.13). For sudden cardiac death, risk was lower for dialysate calcium 1.50 mmol/L (HR, 0.81). With larger serum-to-dialysate calcium gradients, there were significant and positive associations for all outcomes, which were primarily mediated by the serum calcium level.

“This study supports the European Renal Best Practice recommendations that dialysate calcium prescription should be based on consideration of individual patient characteristics,” the authors wrote.

More information:
Karlien J ter Meulen et al, The effects of dialysate calcium prescription on mortality outcomes in incident patients on hemodialysis, Clinical Kidney Journal (2024). DOI: 10.1093/ckj/sfae288

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