Review Article

Arterial Stiffness and Dialysis Calcium Concentration

Table 1

Summary of studies evaluating the effects of dialysis calcium concentration on arterial stiffness in dialysis.

ReferencesPopulation ( )Dialysis CaDurationStiffness indexResults

Marchais et al. (1989) [23]26 HD1.5 mM versus 1.75 mM1 HD per DCaAortic PWV, brachial PWV(i) 1.5 mM: Slight ↑ iCa, brachial and aortic PWV unchanged
(ii) 1.75 mM: ↑ iCa, ↑ brachial and aortic PWV

Kyriazis et al. (2000) [24]19 HD1.25 mM versus 1.75 mM (crossover)4 HD per DCaEstimated brachial artery compliance (oscillometric pulse wave analysis and estimation of brachial artery diameter)(i) 1.25 mM: iCa stable, ↑ AC
(ii) 1.75 mM: ↑ iCa, ↑ AC

Yoo et al. (2004) [25]8 HD1.75 mM (baseline) 1.25 mM 1.75 mM10 HD per DCaCarotid arterial compliance (carotid ultrasound and brachial pulse pressure)(i) 1.25 mM: iCa, ↑ AC
(ii) 1.75 mM: ↑ iCa, AC

Kyriazis et al. (2007) [26]14 HD1.25 mM versus 1.75 mM1 HD per DCaStiffness index (SI), reflection index (RI) derived from the digital volume pulse waveform(i) 1.25 mM: iCa, SI and RI unchanged
(ii) 1.75 mM: ↑ iCa, ↑ SI, ↑ RI

Leboeuf et al. (2009) [29]18 HD1.00 mM versus 1.25 mM versus 1.50 mM (Latin square crossover)1 HD per DCaBrachial PWV, aortic PWV, augmentation index (AI)(i) Association between ΔiCa and relative changes in brachial and aortic stiffness, independent of BP
(ii) Postdialysis reduction of augmentation index, independent of DCa or ΔiCa

Demirci et al. (2008) [30]49 PD1.25 mM versus 1.75 mM (observational study of prevalent cases)6 monthsBrachial PWV, augmentation index (AI)(i) PWV identical at baseline in both groups,
(ii) PWV increased in the high-calcium group during study (not adjusted for BP)

HD: hemodialysis; PD: peritoneal dialysis; BP: blood pressure; iCa: ionized calcium; Δ iCa: changes in iCa; PWV: pulse wave velocity; AC: arterial compliance; AI: augmentation index.