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. 2025 Dec;47(1):2536194.
doi: 10.1080/0886022X.2025.2536194. Epub 2025 Aug 4.

Clinical outcomes and dialysate calcium concentrations in Chinese patients on maintenance hemodialysis: a retrospective cohort study

Yurong Pan  1 , Yunhan He  2 , Yunyan Murong  1 , Juan Xu  1 , Wenqin Yang  1 , Wenyan Guo  1 , Jianlin Jian  1 , Haiwen An  1 , Yanlin Li  1 , Qingxiu Huang  1 , Linna Liu  1
Affiliations

Clinical outcomes and dialysate calcium concentrations in Chinese patients on maintenance hemodialysis: a retrospective cohort study

Yurong Pan et al. Ren Fail. 2025 Dec.

Abstract

Background: The appropriate concentration of dialysate calcium (DCa) for maintenance hemodialysis (MHD) patients remains a subject of ongoing debate. The relationship between DCa concentration and patient outcomes is not yet well established. This study aimed to evaluate the impact of DCa concentration on mortality and major adverse cardiovascular and cerebrovascular events (MACCEs) in Chinese patients undergoing MHD.

Methods: A retrospective matched cohort study was conducted, analyzing data from hemodialysis (HD) patients at our center over the past five years. Each patient in the low DCa group was matched with a counterpart from the mid DCa group. Outcomes, including mortality, MACCE rates, fracture rates, and hospitalization rates, were compared between the two groups.

Results: The study included 924 MHD patients, of whom 101 low DCa patients were matched with 101 mid DCa patients. In the matched-pair analysis, no significant difference was observed in all-cause mortality between the low DCa and mid DCa groups (3.5/100 vs. 4.7/100 patient-years). However, the low DCa group exhibited lower cumulative rates of MACCEs, hospitalization, and fracture incidence compared with the mid DCa group (7.3/100 vs. 20.7/100 patient-years, 21.5/100 vs. 34/100 patient-years, and 1.6/100 vs. 3.9/100 patient-years, respectively). In addition, the adjusted hazard ratio (HR) for the occurrence of first MACCE in the low DCa group compared with the mid DCa group was 0.47 (95% CI: 0.24-0.91).

Conclusions: These findings suggest that low DCa concentrations are associated with reduced rates of MACCEs, hospitalization, and cumulative fracture incidence in MHD patients relative to mid DCa concentrations.

Keywords: Maintenance hemodialysis; dialysate calcium concentration; matched-pair analysis; mortality.

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Conflict of interest statement

No potential conflicts of interest were reported by the author(s).

Figures

Figure 1.
Figure 1.
Study profile. MHD: maintenance hemodialysis; DCa: dialysate calcium.
Figure 2.
Figure 2.
Kaplan-Meier Survival for the 1.25mml/L DCa group and matched 1.5 mmol/L DCa group patients. DCa: dialysate calcium.
Figure 3.
Figure 3.
Kaplan-Meier MACCE estimates and fracture for the 1.25 mmol/L DCa group and matched 1.5 mmol/L DCa group patients. MACCEs, main adverse cardiovascular and cerebrovascular events; DCa: dialysate calcium.
Figure 4.
Figure 4.
Kaplan-Meier Curves for mortality and MACCE estimates stratified by iPTH levels. A: Mortality in the low iPTH group; B: MACCEs probability in the low iPTH group; C: Mortality in the high iPTH group; D: MACCEs probability in the high iPTH group. MACCEs, main adverse cardiovascular and cerebrovascular events; DCa: dialysate calcium; iPTH: intact-parathyroid hormone.
See this image and copyright information in PMC

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