Effect of Changes in Dialysate Bicarbonate on Serum Calcification Propensity and Calciprotein Particles in Hemodialysis Patients

Effect of Dialysate Bicarbonate Prescription on Serum Calcification Propensity and Calciprotein Particles in Hemodialysis Patients

This is a single-center, prospective, proof-of-priciple, pilot study in 24 end-stage renal disease patients on chronic hemodiaysis.

This single-arm, proof-of-principle study will be conducted at the dialysis facility of the Ordensklinikum Linz Elisabethinen Hospital. The dialysate bicarbonate prescription will be decreased from standard of care (usually 35mmol/l) in a stepwise fashion (2 mmol/l per change) to 27 mmol/l and subsequentially increased in a stepwise fashion (2 mmol/l per change) to 37 mmol/l over the course of 6 weeks.

Inclusion Criteria:

• age ≥18 years
• chronic (≥3 months) treatment with hemodialysis or hemodiafiltration
• stable clinical condition

Exclusion Criteria:

• inability to provide informed consent
• dialysis treatment less than thrice weekly
• morbid obesity (body mass index >40 kg/m2)
• chronic inflammation (C reactive protein >10 mg/dL, reference: <0.5 g/dL)
• current immunosuppressive medication,
• severe chronic obstructive pulmonary disease (COPD stage III or IV)
• history of severe hypercapnia or hypoxemia
• overt congestive heart failure
• history of severe hypokalemia (<3.0 mmol/l) or hyperkalemia (>6.5 mmol/L) within 3 months prior to study inclusion.