The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease: A Randomized, Controlled Clinical Trial

Serum calcification propensity is a novel functional test that quantifies the functionality of the humeral system of calcification control. Serum calcification propensity is measured by T , the time taken to convert from primary to secondary calciprotein particle in the serum. Lower T represents hig...

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Vydané v:Clinical journal of the American Society of Nephrology Ročník 13; číslo 9; s. 1373
Hlavní autori: Bressendorff, Iain, Hansen, Ditte, Schou, Morten, Pasch, Andreas, Brandi, Lisbet
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 07.09.2018
Predmet:
Aged
Aged, 80 and over
Calcinosis - blood
Calcinosis - etiology
Calcium Phosphates - blood
Dialysis Solutions - chemistry
Double-Blind Method
Female
Hematologic Tests
Humans
Kidney Failure, Chronic - blood
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - therapy
Magnesium - administration & dosage
Magnesium - analysis
Magnesium - pharmacology
Male
Middle Aged
Propensity Score
Renal Dialysis
Phosphates
cardiovascular disease
parathyroid hormone
Confidence Intervals
calcium
end stage kidney disease
chronic hemodialysis
Dialysis Solutions
Bicarbonates
magnesium
alpha-2-HS-Glycoprotein
randomized controlled trials
mineral metabolism
Calcification, Physiologic
Kidney Failure, Chronic
Humerus
renal dialysis
ISSN:1555-905X, 1555-905X
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Shrnutí:Serum calcification propensity is a novel functional test that quantifies the functionality of the humeral system of calcification control. Serum calcification propensity is measured by T , the time taken to convert from primary to secondary calciprotein particle in the serum. Lower T represents higher calcification propensity and is associated with higher risk of cardiovascular events and death in patients with ESKD. Increasing magnesium in serum increases T , but so far, no clinical trials have investigated whether increasing serum magnesium increases serum calcification propensity in subjects with ESKD. We conducted a single-center, randomized, double-blinded, parallel group, controlled clinical trial, in which we examined the effect of increasing dialysate magnesium from 1.0 to 2.0 mEq/L for 28 days compared with maintaining dialysate magnesium at 1.0 mEq/L on T in subjects undergoing hemodialysis for ESKD. The primary end point was the value of T at the end of the intervention. Fifty-nine subjects were enrolled in the trial, and of these, 57 completed the intervention and were analyzed for the primary outcome. In the standard dialysate magnesium group, T was 233±81 minutes (mean±SD) at baseline (mean of days -7 and 0) and 229±93 minutes at follow-up (mean of days 21 and 28), whereas in the high dialysate magnesium group, T was 247±69 minutes at baseline and 302±66 minutes at follow-up. The difference in T between the two groups at follow-up (primary analysis) was 73 minutes (between-group difference; 95% confidence interval, 30 to 116; <0.001), and the between-group difference in serum magnesium was 0.88 mg/dl (95% confidence interval, 0.66 to 1.10; =0.001). Increasing dialysate magnesium increases T and hence, decreases calcification propensity in subjects undergoing maintenance hemodialysis. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_21_CJASNPodcast_18_9_B.mp3.
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ISSN:1555-905X
1555-905X
DOI:10.2215/CJN.13921217