Premium
High‐calcium dialysate: A factor associated with inflammation, malnutrition and mortality in non‐diabetic maintenance haemodialysis patients
Author(s) -
HSU CHINGWEI,
LIN JALIANG,
LINTAN DANTZU,
YEN TZUNGHAI,
CHEN KUANHSING,
HUANG WENHUNG,
HO TAICHIN,
HUANG YENLIN
Publication year - 2010
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2009.01202.x
Subject(s) - medicine , wasting , malnutrition , dialysis , calcium , hazard ratio , population , risk factor , confidence interval , gastroenterology , body mass index , incidence (geometry) , physics , environmental health , optics
Aim: Chronic inflammation, which is common in dialysis patients, often causes malnutrition and even protein‐energy wasting. However, the association of high‐calcium dialysate with malnutrition and/or inflammation in non‐diabetic maintenance haemodialysis patients remains unclear. This study investigated the possible adverse effects of high‐calcium dialysate and mortality in this population. Methods: A total of 717 non‐diabetic haemodialysis patients participated in this 2 year prospective study. The subjects were categorized into three subgroups based on whether dialysate calcium concentrations were high (3.5 mEq/L), standard (3.0 mEq/L) or low (2.5 mEq/L). Demographic, haematological, nutritional and inflammatory markers, biochemical and dialysis‐related data were obtained for cross‐sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup. Results: Patients with high‐calcium dialysate ( n = 82) had a higher incidence of malnutrition and inflammation (61.0% vs 44.1% and 43.9%, respectively) than those with standard‐ and low‐calcium dialysate ( n = 528 and 107). Backward stepwise multiple regression analysis revealed that high‐calcium dialysate was negatively correlated with nutritional index, serum albumin levels, but positively associated with the inflammatory marker of serum ferritin levels. At the end of the 2 year follow up, 45 patients had died. Cox multivariate analysis demonstrated that high‐calcium dialysate was a significant associated factor (relative risk 2.765; 95% confidence interval 1.429–5.352) for 2 year all‐cause mortality in these patients. Conclusion: The analytical results indicate that high‐calcium dialysate is associated with malnutrition and inflammation as well as 2 year mortality in non‐diabetic maintenance haemodialysis patients and the findings suggest that this population, even those with optimal mineral balance, should avoid high‐calcium dialysate.