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- OpenAccess
A Retrospective Cohort Study on the Association Between Dialysate Calcium Concentration and Clinical Outcomes in Hemodialysis Patients: Comparing Medium-Low and Extremely Low Calcium Concentrations
摘要
BACKGROUND: Hemodialysis (HD) patients have a higher mortality rate than the non-dialysis population. Apart from the hyperphosphatemia and elevated calcium-phosphorus (Ca × P) product, elevated serum calcium is also linked to increased mortality. Lowering hypercalcemia while reducing serum phosphorus is crucial. As dialysate calcium (DCa) concentration is related to the calcium balance, this study aims to clarify whether an extremely-low dialysate calcium (EL-DCa) concentration enhances the clinical prognosis of HD patients. METHODS: A total of 633 patients who underwent HD were studied. The patients were divided into the medium-low dialysate calcium (2.5 and 3.0 mEq/L, ML-DCa) group and the EL-DCa (2.0 mEq/L) group. We compared the overall survival rate between the two groups by Kaplan-Meier survival analysis. Multivariate Cox hazard regression analysis was used for adjusting potential confounding factors. RESULTS: The overall survival rates between the EL-DCa group and the ML-DCa group were 75.9% and 47.3%, respectively, with a log-rank test, χ^2 = 12.840, P < 0.001. Multivariate Cox hazard regression analysis revealed that DCa, age, hemodialysis duration, albumin, creatinine, Ca × P product, and hypertension were independent risk factors for the overall survival. After adjusting confounding factors by multivariate Cox hazard regression, the EL-DCa group still exhibited a statistically significant better survival rate, with a P-value of 0.039. CONCLUSION: HD of EL-DCa, compared with ML-DCa, have better overall survival. Even after undergoing multivariate adjustment, such advantages persist.