The Role of Daily Dialysate Calcium Exposure in Phosphaturic Hormones in Dialysis Patients
Abstract
:1. Introduction
2. Materials and Methods
- -
- a known diagnosis of oncologic disease with bone involvement;
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- chronic inflammatory bowel disease;
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- primary or tertiary hyperparathyroidism or parathyroidectomy;
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- the presence of a colostomy;
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- concomitant therapy with bisphosphonates or denosumab.
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- demographic data: gender, age, and dialytic vintage;
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- comorbidity such as diabetes, hypertension, and dyslipidemia;
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- blood examinations: calcium, phosphorus, magnesium, PTH, vitamin D 25-OH, albumin, cholesterol, triglycerides, urea, ferritin, C-terminal telopeptide (CTX), and FGF-23. Calcium corrected by albumin levels (calciumAlb) was considered. In HD patients, the blood sample was taken at the first weekly session between 7 and 8 a.m., while in PD patients, blood samples were taken on weekdays between 7 and 8 a.m.
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- urine output in 24 h;
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- home therapy (vitamin D and analogs, phosphorus binders, and calcium mimetics). Specifically, the dose of phosphorus binders (sevelamer carbonate, calcium carbonate, lanthanum carbonate, aluminum salts, and sucroferric oxyhydrox-idein) in the 24 h before blood collection was considered. The weekly cumulative dose for vitamin D analogs and calcium mimetics was calculated to avoid possible unevenness in the dosage assessment between HD and PD. Furthermore, the equivalent dose for calcitriol and paracalcitol was estimated, considering that 0.01 mcg/kg calcitriol corresponds to 0.04 mcg/kg paracalcitol. Instead, the following formula was used to compare the cinacalcet and etelcalcetide doses: etelcalcetide/session = 0.111 × mg cinacalcet/day + 0.96 [11].
- (1)
- Hours of exposure to dialysate solution in the 24 h preceding sampling;
- (2)
- (3)
- Hours of exposure to 1.25 mmol/L calcium dialysate solution in the 24 h preceding sampling;
- (4)
- Hours of exposure to 1.75 mmol/L calcium dialysate solution in the 24 h preceding sampling.
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- no calcium bath exposure in the previous 6 h before the blood sample (CAPD with empty abdomen at night);
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- calcium bath exposure (1.25 mmol/L) in the previous 6 h before the blood sample (APD without any exchange during the day, CCPD with and without icodextrin, and CAPD without overnight icodextrin);
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- calcium bath exposure 1.75 mmol/L in the previous 6 h before the blood sample (CAPD with overnight icodestrin).
3. Results
4. Discussion
5. Conclusions
6. Patents
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | Total (=71) | Peritoneal Dialysis (=40) | Hemodialysis (=31) | p |
---|---|---|---|---|
Male (n%) | 41 (57.7%) | 13 (31.7%) | 17 (54.8%) | 0.059 |
Diabetes (n%) | 23 (32.4%) | 9 (22.5%) | 14 (45.1%) | 0.043 |
Hypertension (n%) | 64 (90.1%) | 35 (87.5%) | 29 (93.5%) | 0.39 |
Age (years) | 68.7 (±13.6) | 65.9 (±13.3) | 72.2 (±13.2) | 0.053 |
Dialytic Vintage (years) | 3 (2–4) | 2 (2–3) | 4 (2–6) | 0.009 |
Urine out-put (cc/d) | 800 (300–1300) | 1000 (500–1575) | 600 (0–830) | 0.006 |
CalciumAlb (mmol/L) | 2.33 (±0.19) | 2.39 (±0.17) | 2.26 (±0.2) | 0.009 |
Phosphate (mmol/L) | 1.5 (1.32–1.81) | 1.59 (1.3–1.8) | 1.45 (1.3–1.7) | 0.63 |
Magnesium (mmol/L) | 0.91 (±0.19) | 0.99 (±0.18) | 0.8 (±0.18) | <0.001 |
PTH (ng/L) | 194 (130–316) | 238 (162–355) | 159 (100–229) | 0.006 |
FGF-23 (pg/mL) | 1296 (396–2698) | 1630 (521–3976) | 780 (389–1806) | 0.048 |
CTX (pg/mL) | 2336 (1402–4525) | 2341 (1614–4558) | 2336 (1364–4525) | 0.56 |
Haemoglobin (g/L) | 107 (98–118) | 108 (99.7–120) | 107 (94–117) | 0.65 |
Albumin (g/L) | 33.5 (±4.6) | 33.6 (±4.3) | 33.4 (±4.9) | 0.83 |
Cholesterol (mg/dL) | 147 (117–174) | 145 (114–172) | 147 (121–176) | 0.82 |
Triglycerides (mg/dL) | 121 (86–166) | 121 (81–183) | 121 (89–155) | 0.76 |
Urea (mmol/L) | 20.3 (16.4–22.9) | 18.6 (16.4–22.5) | 21.9 (16.5–23.7) | 0.14 |
Kt/V | NA | 2.08 (1.78–2.4) | 1.2 (1.06–1.35) | NA |
Ca-Dialysate (mmol/L) | 1.25 (0–1.25) | 1.25 (1.25–1.25) | 0 (0–0) | <0.001 |
1.25 CaExp (hours) | 7 (0–9) | 9 (8.1–12) | 0 (0–0) | <0.001 |
1.75 CaExp (hours) | 0 (0–10) | 4 (0–14) | 0 (0–0) | <0.001 |
Cholecalciferol dose (UI/week) | 0 (0–5000) | 5000 (0–6250) | 0 (0–0) | <0.001 |
Calcitriol equivalent dose (mcg/week) | 1.75 (1.25–3.75) | 1.75 (0–1.75) | 3.25 (3.5–3.75) | 0.007 |
Cinacalcet equivalent dose (mg/week) | 0 (0–0) | 0 (0–78.7) | 0 (0–0) | 0.62 |
Calcium based binder dose (g/d) | 0 (0–1) | 0 (0–1) | 0 (0–1) | 0.75 |
Rho | p | |
---|---|---|
Ca-Dialysate (mmol/L) | 0.41 | 0.008 |
1.25 CaExp (h) | 0.35 | 0.003 |
1.75 CaExp (h) | 0.27 | 0.025 |
Cholecalciferol dose (UI/week) | 0.36 | 0.002 |
Calcitriol equivalent dose (mcg/week) | 0.54 | 0.66 |
Cinacalcet equivalent dose (mg/week) | 0.03 | 0.81 |
Ca-Based P binder dose (g/d) | −0.031 | 0.80 |
A. Univariate Regression Analysis | |||
Beta-Coefficient | p | 95% IC | |
Age | −0.25 | 0.038 | −0.02 −0.021 |
Urine output | 0.116 | 0.33 | −0.02 0.00 |
Ca-Dialysate | 0.29 | 0.014 | 0.05 0.45 |
1.25 CaExp | 0.25 | 0.039 | 0.001 0.05 |
1.75 CaExp | −0.28 | 0.82 | −0.3 0.2 |
CalciumAlb | −0.12 | 0.31 | −1.12 0.36 |
Phosphate | 0.28 | 0.016 | 0.8 0.76 |
Magnesium | 0.18 | 0.13 | −0.16 1.31 |
FGF-23 (pg/mL) | 0.12 | 0.3 | −0.00 0.00 |
CTX (pg/mL) | 0.3 | 0.011 | 0.00 0.00 |
Cholecalciferol dose | 0.03 | 0.82 | 0.00 0.00 |
Calcitriol equivalent dose | −0.11 | 0.35 | −0.15 0.05 |
Cinacalcet equivalent dose | 0.25 | 0.04 | 0.00 0.003 |
Ca-Based P binder Dose | 0.12 | 0.31 | −0.77 0.24 |
B. Multivariate Regression Analysis | |||
1.25 CaExp | 0.279 | 0.011 | 0.05 0.10 |
P (mmol/L) | 0.277 | 0.012 | 0.09 0.7 |
CTX (pg/mL) | 0.29 | 0.009 | 0.00 0.00 |
A. Univariate Regression Analysis | |||
Beta-Coefficient | p | 95% IC | |
Age | −0.37 | 0.002 | −0.06 −0.01 |
Urine output | 0.08 | 0.48 | −0.00 0.00 |
Ca-Dialysate | 0.26 | 0.027 | 0.06 0.95 |
Exptot | 0.30 | 0.68 | 6.8 48 |
1.25 CaExp | 0.19 | 0.10 | −0.009 0.09 |
1.75 CaExp | 0.21 | 0.08 | −0.006 0.09 |
CalciumAlb | 0.26 | 0.026 | 0.22 3.4 |
Phosphorous | 0.49 | <0.001 | 0.92 2.28 |
Magnesium | 0.29 | 0.013 | 0.43 3.6 |
PTH (ng/L) | −0.006 | 0.96 | −0.002 0.002 |
CTX (pg/mL) | −0.09 | 0.43 | −0.00 0.00 |
Cholecalciferol (UI/week) | 0.16 | 0.18 | 0.00 0.00 |
Calcitriol equivalent dose (mcg/week) | −0.063 | 0.6 | −0.28 0.16 |
Cinacalcet equivalent dose (mg/week) | 0.27 | 0.021 | 0.001 0.007 |
Ca-based P binder dose (g/d) | −0.10 | 0.39 | −0.49 0.2 |
B. Multivariate Regression Analysis | |||
Model A: R = 0.62 | |||
Phosphorous | 0.57 | <0.001 | 1.24 2.5 |
CalciumAlb | 0.38 | <0.001 | 1.32 3.98 |
Model B: R = 0.55 | |||
Phosphorous | 0.48 | <0.001 | 0.93 2.2 |
Ca-Dialysate | 0.25 | 0.015 | 0.09 0.87 |
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Martino, F.K.; di Vico, V.; Basso, A.; Gobbi, L.; Stefanelli, L.F.; Cacciapuoti, M.; Bettin, E.; Del Prete, D.; Scaparrotta, G.; Nalesso, F.; et al. The Role of Daily Dialysate Calcium Exposure in Phosphaturic Hormones in Dialysis Patients. Life 2024, 14, 964. https://doi.org/10.3390/life14080964
Martino FK, di Vico V, Basso A, Gobbi L, Stefanelli LF, Cacciapuoti M, Bettin E, Del Prete D, Scaparrotta G, Nalesso F, et al. The Role of Daily Dialysate Calcium Exposure in Phosphaturic Hormones in Dialysis Patients. Life. 2024; 14(8):964. https://doi.org/10.3390/life14080964
Chicago/Turabian StyleMartino, Francesca K., Valentina di Vico, Anna Basso, Laura Gobbi, Lucia Federica Stefanelli, Martina Cacciapuoti, Elisabetta Bettin, Dorella Del Prete, Giuseppe Scaparrotta, Federico Nalesso, and et al. 2024. "The Role of Daily Dialysate Calcium Exposure in Phosphaturic Hormones in Dialysis Patients" Life 14, no. 8: 964. https://doi.org/10.3390/life14080964