Impact of dialysate calcium concentration on clinical outcomes in incident hemodialysis patients

Hyung Wook Kim, Su Hyun Kim, Young Ok Kim, Dong Chan Jin, Ho Chul Song, Euy Jin Choi, Yong Lim Kim, Yon Su Kim, Shin Wook Kang, Nam Ho Kim, Chul Woo Yang, Yong Kyun Kim

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

The association between dialysate calcium (DCa) concentration and mortality in hemodialysis (HD) patients is controversial. In this study, we evaluated the impact of DCa concentration on mortality in incident HD patient. Incident HD patients were selected from the Clinical Research Center registry-a prospective cohort study on dialysis patients in Korea. Patients were categorized into 3 groups according to the prescribed DCa concentration at the time of enrollment. High DCa was defined as a concentration of 3.5 mEq/L, mid-DCa as 3.0 mEq/L, and low DCa as 2.5 to 2.6 mEq/L. The primary outcome was all-cause mortality and secondary outcomes were cardiovascular or infectionrelated hospitalization. A total of 1182 patients with incident HD were included. The number of patients in each group was 182 (15.4%) in high DCa group, 701 (59.3%) in the mid-DCa group, and 299 (25.3%) in the low DCa group. The median follow-up period was 16 months. The high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.28-3.90, P=0.005) and the low DCa group (HR 3.67, 95% CI 1.78-7.55, P<0.001) after adjustment for clinical variables. The high DCa group was associated with higher risk of cardiovascular and infection-related hospitalization compared with the low DCa group (HR 3.25, 95% CI 1.53-6.89, P=0.002; and HR 2.77, 95% CI 1.29-5.94, P=0.009, respectively). Of these 1182 patients, 163 patients from each group were matched by propensity scores. In the propensity score matched analysis, the high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (HR 2.52, 95% CI 1.04-6.07, P=0.04) and the low DCa group (HR 4.25, 95% CI 1.64-11.03, P=0.003) after adjustment for clinical variables. Our data showed that HD using a high DCa was a significant risk factor for all-cause mortality and cardiovascular or infection-related hospitalization in incident HD patients.

Original languageEnglish
Article numbere1694
JournalMedicine (United States)
Volume94
Issue number40
DOIs
Publication statusPublished - 2015 Oct 9

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Dialysis Solutions
Renal Dialysis
Calcium
Confidence Intervals
Mortality
Cardiovascular Infections
Propensity Score
Hospitalization
Korea

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kim, H. W., Kim, S. H., Kim, Y. O., Jin, D. C., Song, H. C., Choi, E. J., ... Kim, Y. K. (2015). Impact of dialysate calcium concentration on clinical outcomes in incident hemodialysis patients. Medicine (United States), 94(40), [e1694]. https://doi.org/10.1097/MD.0000000000001694
Kim, Hyung Wook ; Kim, Su Hyun ; Kim, Young Ok ; Jin, Dong Chan ; Song, Ho Chul ; Choi, Euy Jin ; Kim, Yong Lim ; Kim, Yon Su ; Kang, Shin Wook ; Kim, Nam Ho ; Yang, Chul Woo ; Kim, Yong Kyun. / Impact of dialysate calcium concentration on clinical outcomes in incident hemodialysis patients. In: Medicine (United States). 2015 ; Vol. 94, No. 40.
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abstract = "The association between dialysate calcium (DCa) concentration and mortality in hemodialysis (HD) patients is controversial. In this study, we evaluated the impact of DCa concentration on mortality in incident HD patient. Incident HD patients were selected from the Clinical Research Center registry-a prospective cohort study on dialysis patients in Korea. Patients were categorized into 3 groups according to the prescribed DCa concentration at the time of enrollment. High DCa was defined as a concentration of 3.5 mEq/L, mid-DCa as 3.0 mEq/L, and low DCa as 2.5 to 2.6 mEq/L. The primary outcome was all-cause mortality and secondary outcomes were cardiovascular or infectionrelated hospitalization. A total of 1182 patients with incident HD were included. The number of patients in each group was 182 (15.4{\%}) in high DCa group, 701 (59.3{\%}) in the mid-DCa group, and 299 (25.3{\%}) in the low DCa group. The median follow-up period was 16 months. The high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (hazard ratio [HR] 2.23, 95{\%} confidence interval [CI] 1.28-3.90, P=0.005) and the low DCa group (HR 3.67, 95{\%} CI 1.78-7.55, P<0.001) after adjustment for clinical variables. The high DCa group was associated with higher risk of cardiovascular and infection-related hospitalization compared with the low DCa group (HR 3.25, 95{\%} CI 1.53-6.89, P=0.002; and HR 2.77, 95{\%} CI 1.29-5.94, P=0.009, respectively). Of these 1182 patients, 163 patients from each group were matched by propensity scores. In the propensity score matched analysis, the high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (HR 2.52, 95{\%} CI 1.04-6.07, P=0.04) and the low DCa group (HR 4.25, 95{\%} CI 1.64-11.03, P=0.003) after adjustment for clinical variables. Our data showed that HD using a high DCa was a significant risk factor for all-cause mortality and cardiovascular or infection-related hospitalization in incident HD patients.",
author = "Kim, {Hyung Wook} and Kim, {Su Hyun} and Kim, {Young Ok} and Jin, {Dong Chan} and Song, {Ho Chul} and Choi, {Euy Jin} and Kim, {Yong Lim} and Kim, {Yon Su} and Kang, {Shin Wook} and Kim, {Nam Ho} and Yang, {Chul Woo} and Kim, {Yong Kyun}",
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Kim, HW, Kim, SH, Kim, YO, Jin, DC, Song, HC, Choi, EJ, Kim, YL, Kim, YS, Kang, SW, Kim, NH, Yang, CW & Kim, YK 2015, 'Impact of dialysate calcium concentration on clinical outcomes in incident hemodialysis patients', Medicine (United States), vol. 94, no. 40, e1694. https://doi.org/10.1097/MD.0000000000001694

Impact of dialysate calcium concentration on clinical outcomes in incident hemodialysis patients. / Kim, Hyung Wook; Kim, Su Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong Lim; Kim, Yon Su; Kang, Shin Wook; Kim, Nam Ho; Yang, Chul Woo; Kim, Yong Kyun.

In: Medicine (United States), Vol. 94, No. 40, e1694, 09.10.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of dialysate calcium concentration on clinical outcomes in incident hemodialysis patients

AU - Kim, Hyung Wook

AU - Kim, Su Hyun

AU - Kim, Young Ok

AU - Jin, Dong Chan

AU - Song, Ho Chul

AU - Choi, Euy Jin

AU - Kim, Yong Lim

AU - Kim, Yon Su

AU - Kang, Shin Wook

AU - Kim, Nam Ho

AU - Yang, Chul Woo

AU - Kim, Yong Kyun

PY - 2015/10/9

Y1 - 2015/10/9

N2 - The association between dialysate calcium (DCa) concentration and mortality in hemodialysis (HD) patients is controversial. In this study, we evaluated the impact of DCa concentration on mortality in incident HD patient. Incident HD patients were selected from the Clinical Research Center registry-a prospective cohort study on dialysis patients in Korea. Patients were categorized into 3 groups according to the prescribed DCa concentration at the time of enrollment. High DCa was defined as a concentration of 3.5 mEq/L, mid-DCa as 3.0 mEq/L, and low DCa as 2.5 to 2.6 mEq/L. The primary outcome was all-cause mortality and secondary outcomes were cardiovascular or infectionrelated hospitalization. A total of 1182 patients with incident HD were included. The number of patients in each group was 182 (15.4%) in high DCa group, 701 (59.3%) in the mid-DCa group, and 299 (25.3%) in the low DCa group. The median follow-up period was 16 months. The high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.28-3.90, P=0.005) and the low DCa group (HR 3.67, 95% CI 1.78-7.55, P<0.001) after adjustment for clinical variables. The high DCa group was associated with higher risk of cardiovascular and infection-related hospitalization compared with the low DCa group (HR 3.25, 95% CI 1.53-6.89, P=0.002; and HR 2.77, 95% CI 1.29-5.94, P=0.009, respectively). Of these 1182 patients, 163 patients from each group were matched by propensity scores. In the propensity score matched analysis, the high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (HR 2.52, 95% CI 1.04-6.07, P=0.04) and the low DCa group (HR 4.25, 95% CI 1.64-11.03, P=0.003) after adjustment for clinical variables. Our data showed that HD using a high DCa was a significant risk factor for all-cause mortality and cardiovascular or infection-related hospitalization in incident HD patients.

AB - The association between dialysate calcium (DCa) concentration and mortality in hemodialysis (HD) patients is controversial. In this study, we evaluated the impact of DCa concentration on mortality in incident HD patient. Incident HD patients were selected from the Clinical Research Center registry-a prospective cohort study on dialysis patients in Korea. Patients were categorized into 3 groups according to the prescribed DCa concentration at the time of enrollment. High DCa was defined as a concentration of 3.5 mEq/L, mid-DCa as 3.0 mEq/L, and low DCa as 2.5 to 2.6 mEq/L. The primary outcome was all-cause mortality and secondary outcomes were cardiovascular or infectionrelated hospitalization. A total of 1182 patients with incident HD were included. The number of patients in each group was 182 (15.4%) in high DCa group, 701 (59.3%) in the mid-DCa group, and 299 (25.3%) in the low DCa group. The median follow-up period was 16 months. The high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.28-3.90, P=0.005) and the low DCa group (HR 3.67, 95% CI 1.78-7.55, P<0.001) after adjustment for clinical variables. The high DCa group was associated with higher risk of cardiovascular and infection-related hospitalization compared with the low DCa group (HR 3.25, 95% CI 1.53-6.89, P=0.002; and HR 2.77, 95% CI 1.29-5.94, P=0.009, respectively). Of these 1182 patients, 163 patients from each group were matched by propensity scores. In the propensity score matched analysis, the high DCa group had a significantly higher risk of all-cause mortality compared with the mid-DCa group (HR 2.52, 95% CI 1.04-6.07, P=0.04) and the low DCa group (HR 4.25, 95% CI 1.64-11.03, P=0.003) after adjustment for clinical variables. Our data showed that HD using a high DCa was a significant risk factor for all-cause mortality and cardiovascular or infection-related hospitalization in incident HD patients.

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