AbstractIntroduction Vascular calcification, specifically medial calcification, is prevalent in hemodialysis patients and leads to poor outcomes. Citrate is present in some hemodialysis solutions and could potentially inhibit vascular calcification. This was examined by comparing the progression of medial arterial calcification, as measured by mammography, in female patients with end-stage renal disease undergoing hemodialysis with and without citrate. Methods In a cross-over study, 28 female chronic in-center hemodialysis (HD) patients with pre-existing breast arterial calcification (BAC) underwent HD using dialysate with or without citrate, each for one 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, or phosphate. Progression of BAC was significantly greater during citrate HD (47, IQR:10 – 124 vs. 9 ,IQR -4 - 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. Citrate was also 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 HD patients and occurs with other therapeutic uses of citrate.
O’Neill et al. (Fri,) studied this question.