Machacek Jennifer, Neufeld Peter S, Pasch Andreas, Gaggl Martina, Haller Maria C, Smith Edward R, Cejka Daniel
Department of Medicine III - Nephrology, Hypertension, Transplantation, Rheumatology, Geriatrics, Ordensklinikum Linz - Elisabethinen Hospital, Linz, Austria.
Institute for Physiology and Pathophysiology, Johannes Kepler University Linz, Austria.
Clin Kidney J. 2025 Aug 13;18(9):sfaf263. doi: 10.1093/ckj/sfaf263. eCollection 2025 Sep.
Short calciprotein crystallization time (low T50) is directly associated with an increased risk of cardiovascular events and mortality. Here, we investigated whether increases in dialysate bicarbonate concentrations increase T50 times in dialysis patients.
In a prospective, single-center, single-arm, interventional trial in hemodialysis patients ( = 29), dialysate bicarbonate was decreased from baseline settings to 27 mmol/L (D-Bic 27) followed by an increase to 37 mmol/L (D-Bic 37), over the course of 6 weeks. The primary endpoint was the change in T50 time between the D-Bic 27 and D-Bic 37 phases. Measurements of endogenous calciprotein monomers (CPM), primary (CPP-1) and secondary (CPP-2) calciprotein particles were pre-specified secondary outcomes.
Twenty-four patients completed the study per protocol. T50 time increased significantly from 246 ± 77 to 282 ± 81 min from the D-Bic 27 to the D-Bic 37 phase ( < .0001). The hydrodynamic radius (size) of secondary calciprotein particles generated in the T50 test (CPP-2) did not differ significantly between study phases (251 ± 75 vs 240 ± 78 nm, = .27). Comparing the D-Bic 27 with the D-Bic 37 phase, CPM (16.8 × 10³ vs 16.2 × 10³ AU/µL, = .9) and CPP-1 (4.6 × 105 vs 4.5 × 10 counts/mL, = .7) did not change significantly, but there was a significant decrease in CPP-2 levels (5.9 × 10 vs 3.2 × 10 counts/mL, < .0003). Intradialytically, T50 increased, CPM and CPP-1 decreased, while CPP-2 remained stable.
Raising dialysate bicarbonate resulted in a significant increase in T50 time and a reduction of CPP-2 levels.
短的钙蛋白结晶时间（低T50）与心血管事件风险和死亡率增加直接相关。在此，我们研究了透析液碳酸氢盐浓度的增加是否会增加透析患者的T50时间。
在一项针对血液透析患者（n = 29）的前瞻性、单中心、单臂干预试验中，透析液碳酸氢盐在6周的过程中从基线设置降至27 mmol/L（D-Bic 27），随后升至37 mmol/L（D-Bic 37）。主要终点是D-Bic 27和D-Bic 37阶段之间T50时间的变化。内源性钙蛋白单体（CPM）、初级（CPP-1）和次级（CPP-2）钙蛋白颗粒的测量是预先指定的次要结果。
24名患者按方案完成了研究。从D-Bic 27阶段到D-Bic 37阶段，T50时间从246±77分钟显著增加到282±81分钟（P <.0001）。T50测试中产生的次级钙蛋白颗粒（CPP-2）的流体动力学半径（大小）在研究阶段之间没有显著差异（251±75对240±78 nm，P =.27）。将D-Bic 27与D-Bic 37阶段进行比较，CPM（16.8×10³对16.2×10³ AU/µL，P =.9）和CPP-1（4.6×10⁵对4.5×10⁵计数/mL，P =.7）没有显著变化，但CPP-2水平有显著下降（5.9×10⁵对3.2×10⁵计数/mL，P <.0003）。在透析过程中，T50增加，CPM和CPP-1减少，而CPP-2保持稳定。
提高透析液碳酸氢盐导致T50时间显著增加和CPP-2水平降低。
