Jennifer Machacek, Peter S Neufeld, Andreas Pasch, Martina Gaggl, Maria C Haller, Edward R Smith, Daniel Cejka
{"title":"碳酸氢盐透析液对血液透析患者钙蛋白颗粒结晶时间（T50）的影响——D-Bic研究。","authors":"Jennifer Machacek, Peter S Neufeld, Andreas Pasch, Martina Gaggl, Maria C Haller, Edward R Smith, Daniel Cejka","doi":"10.1093/ckj/sfaf263","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>In a prospective, single-center, single-arm, interventional trial in hemodialysis patients (<i>N</i> = 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.</p><p><strong>Results: </strong>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 (<i>P</i> < .0001). The hydrodynamic radius (size) of secondary calciprotein particles generated in the T50 test (CPP-2<sub>Rh</sub>) did not differ significantly between study phases (251 ± 75 vs 240 ± 78 nm, <i>P</i> = .27). Comparing the D-Bic 27 with the D-Bic 37 phase, CPM (16.8 × 10³ vs 16.2 × 10³ AU/µL, <i>P</i> = .9) and CPP-1 (4.6 × 105 vs 4.5 × 10<sup>5</sup> counts/mL, <i>P</i> = .7) did not change significantly, but there was a significant decrease in CPP-2 levels (5.9 × 10<sup>4</sup> vs 3.2 × 10<sup>4</sup> counts/mL, <i>P</i> < .0003). Intradialytically, T50 increased, CPM and CPP-1 decreased, while CPP-2 remained stable.</p><p><strong>Conclusions: </strong>Raising dialysate bicarbonate resulted in a significant increase in T50 time and a reduction of CPP-2 levels.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf263"},"PeriodicalIF":4.6000,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421725/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of dialysate bicarbonate on calciprotein particle crystallization time (T50) in hemodialysis patients-the D-Bic study.\",\"authors\":\"Jennifer Machacek, Peter S Neufeld, Andreas Pasch, Martina Gaggl, Maria C Haller, Edward R Smith, Daniel Cejka\",\"doi\":\"10.1093/ckj/sfaf263\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>In a prospective, single-center, single-arm, interventional trial in hemodialysis patients (<i>N</i> = 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.</p><p><strong>Results: </strong>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 (<i>P</i> < .0001). The hydrodynamic radius (size) of secondary calciprotein particles generated in the T50 test (CPP-2<sub>Rh</sub>) did not differ significantly between study phases (251 ± 75 vs 240 ± 78 nm, <i>P</i> = .27). Comparing the D-Bic 27 with the D-Bic 37 phase, CPM (16.8 × 10³ vs 16.2 × 10³ AU/µL, <i>P</i> = .9) and CPP-1 (4.6 × 105 vs 4.5 × 10<sup>5</sup> counts/mL, <i>P</i> = .7) did not change significantly, but there was a significant decrease in CPP-2 levels (5.9 × 10<sup>4</sup> vs 3.2 × 10<sup>4</sup> counts/mL, <i>P</i> < .0003). Intradialytically, T50 increased, CPM and CPP-1 decreased, while CPP-2 remained stable.</p><p><strong>Conclusions: </strong>Raising dialysate bicarbonate resulted in a significant increase in T50 time and a reduction of CPP-2 levels.</p>\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":\"18 9\",\"pages\":\"sfaf263\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-08-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421725/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfaf263\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfaf263","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：钙蛋白结晶时间短（低T50）与心血管事件和死亡率增加直接相关。在这里，我们研究了透析液碳酸氢盐浓度的增加是否会使透析患者的T50倍增加。方法：在一项对血液透析患者（N = 29）进行的前瞻性、单中心、单臂、介入性试验中，在6周的时间里，透析液碳酸氢盐从基线降低到27 mmol/L (D-Bic 27)，随后增加到37 mmol/L （D-Bic 37）。主要终点是D-Bic 27期和D-Bic 37期T50时间的变化。内源性钙蛋白单体（CPM）、初级（cpp1）和次级（cpp2）钙蛋白颗粒的测量是预先指定的次要结果。结果：每个方案有24例患者完成了研究。从D-Bic 27期到D-Bic 37期，T50时间从246±77分钟显著增加到282±81分钟（P Rh），不同研究阶段之间差异不显著（251±75 nm vs 240±78 nm, P = 0.27）。D-Bic 27与D-Bic 37相比较，CPM （16.8 × 10³vs 16.2 × 10³AU/µL, P = 0.9）和cpp1 （4.6 × 105 vs 4.5 × 105计数/mL， P = 0.7）无显著变化，但cpp2水平显著降低（5.9 × 104 vs 3.2 × 104计数/mL， P）。结论：提高碳酸氢盐透析液可显著增加T50时间，降低cpp2水平。
Effect of dialysate bicarbonate on calciprotein particle crystallization time (T50) in hemodialysis patients-the D-Bic study.
Background: 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.
Methods: In a prospective, single-center, single-arm, interventional trial in hemodialysis patients (N = 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.
Results: 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 (P < .0001). The hydrodynamic radius (size) of secondary calciprotein particles generated in the T50 test (CPP-2Rh) did not differ significantly between study phases (251 ± 75 vs 240 ± 78 nm, P = .27). Comparing the D-Bic 27 with the D-Bic 37 phase, CPM (16.8 × 10³ vs 16.2 × 10³ AU/µL, P = .9) and CPP-1 (4.6 × 105 vs 4.5 × 105 counts/mL, P = .7) did not change significantly, but there was a significant decrease in CPP-2 levels (5.9 × 104 vs 3.2 × 104 counts/mL, P < .0003). Intradialytically, T50 increased, CPM and CPP-1 decreased, while CPP-2 remained stable.
Conclusions: Raising dialysate bicarbonate resulted in a significant increase in T50 time and a reduction of CPP-2 levels.
期刊介绍：
About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
