Kidney international reports · 2026
Effect of Hemodialysis With Citrate on Vascular Calcification.
СтатьяНазвание и аннотация: Перевод в очереди
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O'Neill W Charles, Navarrete Jose, Young Michelle, Dabeer Sadaf
Аннотация
INTRODUCTION: Vascular calcification, specifically medial calcification, is prevalent in patients undergoing hemodialysis (HD) and leads to poor outcomes. Citrate is present in some HD solutions and could potentially inhibit vascular calcification. This was examined by comparing the progression of medial arterial calcification, as measured using mammography, in female patients with end-stage renal disease (ESRD) undergoing HD with and without citrate.
METHODS: In a cross-over study, 28 female chronic in-center HD patients with preexisting breast arterial calcification (BAC) underwent HD using dialysate with or without citrate, each for 1 year with BAC measured at 6-month intervals. In addition, citrate was measured in calcified human arteries.
RESULTS: HD with citrate increased post-HD plasma citrate over 200% with no changes in pre-HD levels of citrate, calcium (Ca), or phosphate. Progression of BAC was significantly greater during citrate HD (47, interquartile range [IQR]:10-124 vs. 9 , IQR: -4 to 34 mm/yr, P = 0.0005), with 79% of subjects having greater progression during citrate HD. Citrate was present in calcified human arteries and correlated with the degree of calcification (r = 0.91).
CONCLUSION: HD with citrate unexpectedly promoted vascular calcification, which could not be explained by other dialysis parameters or changes in mineral metabolism. In addition, citrate was associated with vascular calcifications at levels approaching those reported in bone. The results are consistent with known effects of citrate to promote biomineralization and bone formation. Further studies are needed to determine whether this effect of citrate leads to adverse clinical outcomes in patients undergoing HD and occurs with other therapeutic uses of citrate.
METHODS: In a cross-over study, 28 female chronic in-center HD patients with preexisting breast arterial calcification (BAC) underwent HD using dialysate with or without citrate, each for 1 year with BAC measured at 6-month intervals. In addition, citrate was measured in calcified human arteries.
RESULTS: HD with citrate increased post-HD plasma citrate over 200% with no changes in pre-HD levels of citrate, calcium (Ca), or phosphate. Progression of BAC was significantly greater during citrate HD (47, interquartile range [IQR]:10-124 vs. 9 , IQR: -4 to 34 mm/yr, P = 0.0005), with 79% of subjects having greater progression during citrate HD. Citrate was present in calcified human arteries and correlated with the degree of calcification (r = 0.91).
CONCLUSION: HD with citrate unexpectedly promoted vascular calcification, which could not be explained by other dialysis parameters or changes in mineral metabolism. In addition, citrate was associated with vascular calcifications at levels approaching those reported in bone. The results are consistent with known effects of citrate to promote biomineralization and bone formation. Further studies are needed to determine whether this effect of citrate leads to adverse clinical outcomes in patients undergoing HD and occurs with other therapeutic uses of citrate.