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Citric acid-based bicarbonate dialysate attenuates aortic arch calcification in maintenance hemodialysis patients: a retrospective observational study

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Abstract

Background

Progression of aortic calcification is associated with all-cause and cardiovascular mortality in hemodialysis patients. Blood calciprotein particle (CPP) levels are associated with coronary artery calcification and were reported to be inhibited when using citric acid-based bicarbonate dialysate (CD). Therefore, this study aimed to examine the effect of CD on the progression of the aortic arch calcification score (AoACS) and blood CPP levels in hemodialysis patients.

Methods

A 12-month retrospective observational study of 262 hemodialysis patients was conducted. AoACS was evaluated by calculating the number of calcifications in 16 segments of the aortic arch on chest X-ray (minimum score is 0; maximum score is 16 points). The patients were divided into the following groups according to their baseline AoACS: grade 0, AoACS = 0 points; grade 1, AoACS 1–4 points; grade 2, AoACS 5–8 points; grade 3, AoACS 9 points or higher. Patients on bisphosphonates or warfarin or with AoACS grade 3 were excluded. Progression, defined as ΔAoACS (12-month score – baseline score) > 0 points, was compared between the CD and acetic acid-based bicarbonate dialysate (AD) groups before and after adjusting the background using propensity score matching.

Results

The AoACS progression rate was significantly lower in the CD group than in the AD group (before matching: P = 0.020, after matching: P = 0.002). Multivariate logistic regression analysis showed that CD was significantly associated with AoACS progression (odds ratio 0.52, 95% confidence interval 0.29‒0.92, P = 0.025).

Conclusion

CD may slow the progression of vascular calcification in hemodialysis patients.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are very grateful to Naganuma Toshiaki, a clinical engineering technician, for his contribution to this study.

Funding

This work was supported by JSPS KAKENHI under Grant Number JP19K17723.

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Authors and Affiliations

  1. Department of Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-ku, Tokyo, 1628666, Japan

    Ken-ichi Akiyama, Takahito Moriyama, Momoko Seki, Yusuke Ushio, Kentaro Kawasoe, Yoei Miyabe, Kazunori Karasawa, Keiko Uchida, Kosaku Nitta & Junichi Hoshino

  2. Department of Nephrology, Tokyo Medical University, 6-7-1, Nishishinjyuku, Shinjuku-ku, Tokyo, 1600023, Japan

    Takahito Moriyama

  3. Department of Blood Purification, Tokyo Women’s Medical University, Tokyo, Japan

    Norio Hanafusa

  4. Division of Anti-Aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Shimotsuke, Japan

    Yutaka Miura & Makoto Kuro-o

  5. Department of Nephrology, Division of Medicine, Saiseikai Kurihashi Hospital, Kuki, Saitama, Japan

    Hidekazu Sugiura

  6. Department of Nephrology, Joban Hospital, Iwaki-city, Fukushima, Japan

    Masayuki Okazaki, Mizuki Komatsu & Hiroshi Kawaguchi

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  1. Ken-ichi Akiyama
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Contributions

All authors contributed to the study’s conception and design. CPP and FGF23 measurements in the blood and interpretation of the data were performed by YM and MK. Material preparation and data collection and analysis were performed by KA, NH, and TM. The first draft of the manuscript was written by KA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takahito Moriyama.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

This study adhered to the tenets of the Declaration of Helsinki and was approved by the Medical Ethics committee of Joban Hospital, Iwaki-city, Fukushima, Japan (JHTF-2018-018, JHTF-2020-008).

Consent to participate

Consent for participation in this study was obtained on an opt-out basis from patients who had already provided written informed consent for the use of residual plasma in regular practice for research purposes.

Consent to publish

Patients provided written informed consent regarding the publication of their data and chest X-ray findings.

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Akiyama, Ki., Moriyama, T., Hanafusa, N. et al. Citric acid-based bicarbonate dialysate attenuates aortic arch calcification in maintenance hemodialysis patients: a retrospective observational study. J Nephrol 36, 367–376 (2023). https://doi.org/10.1007/s40620-022-01470-2

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