Nishibori Nobuhiro, Okazaki Masaki, Miura Yutaka, Hishida Manabu, Kurasawa Shimon, Imaizumi Takahiro, Kato Noritoshi, Kosugi Tomoki, Kuro-O Makoto, Kasuga Hirotake, Kaneda Fumika, Maruyama Shoichi
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Clin Kidney J. 2024 May 6;17(6):sfae121. doi: 10.1093/ckj/sfae121. eCollection 2024 Jun.
Extended-hours haemodialysis (HD) is associated with better clinical outcomes than conventional HD. We investigated whether extended-hours HD and conventional HD have varying effects on blood levels of calciprotein particles (CPPs) and phosphorus, which have been identified as major pathogenic molecules for vascular calcification.
Patients who underwent conventional or extended in-centre daytime HD between January and March 2020 were included. Plasma CPP levels, representing only secondary CPPs (CPP-II), were measured in pre-dialysis samples. Linear and non-linear associations between CPPs and serum phosphorus levels were examined across dialysis modalities.
A total of 382 participants (185 undergoing extended-hours HD and 197 undergoing conventional HD) were included in the analysis. The median age of participants was 71 years, 65% of the patients were men and the mean phosphorus level was 5.4 mg/dl. Plasma CPP (CPP-II) levels were lower in the extended-hours HD group than in the conventional HD group [40 018 (arbitrary units) AU versus 75 728 AU; < .01]. Multivariable linear regression analysis showed that extended-hours HD was associated with lower natural logarithmic plasma CPP (CPP-II) levels: -0.64 (95% confidence interval -0.74 to -0.55). A restricted cubic spline function indicated that extended-hours HD was associated with lower plasma CPP (CPP-II) levels across levels of serum phosphorus, with significant differences observed between groups, especially in hyperphosphataemic conditions ( for interaction <.01).
The extended-hours HD group had lower CPP levels than the conventional HD group despite no significant differences in serum phosphorus levels, which may contribute to better clinical outcomes in patients on extended-hours HD.
与传统血液透析（HD）相比，延长时间的血液透析与更好的临床结局相关。我们研究了延长时间的HD和传统HD对钙蛋白颗粒（CPPs）和磷的血液水平是否有不同影响，CPPs和磷已被确定为血管钙化的主要致病分子。
纳入2020年1月至3月期间接受传统或延长时间的中心日间HD的患者。在透析前样本中测量代表仅继发性CPPs（CPP-II）的血浆CPP水平。在不同透析方式下检查CPPs与血清磷水平之间的线性和非线性关联。
共有382名参与者（185名接受延长时间的HD，197名接受传统HD）纳入分析。参与者的中位年龄为71岁，65%的患者为男性，平均磷水平为5.4mg/dl。延长时间的HD组血浆CPP（CPP-II）水平低于传统HD组[40018（任意单位）AU对75728AU；<0.01]。多变量线性回归分析显示，延长时间的HD与较低的自然对数血浆CPP（CPP-II）水平相关：-0.64（95%置信区间-0.74至-0.55）。受限立方样条函数表明，在血清磷水平范围内，延长时间的HD与较低的血浆CPP（CPP-II）水平相关，组间观察到显著差异，尤其是在高磷血症情况下（交互作用<0.01）。
尽管血清磷水平无显著差异，但延长时间的HD组CPP水平低于传统HD组，这可能有助于延长时间的HD患者获得更好的临床结局。
