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The complement system plays an important role in cardiovascular disease in patients on hemodialysis. Vascular calcification is also one of the major causes of cardiovascular disease. We want to investigate the relationship between complement activation and vascular calcification in dialyzed patients. One hundred eight hemodialysis patients and 65 heathy controls were enrolled prospectively. Plasma C3a, C5a, mannose-binding lectin (MBL), and membrane attack complex (MAC or C5b-9) levels were detected using ELISA. Plasma C3c, fB, fH, C1q, and C4 levels were measured by immunity transmission turbidity. Abdominal aortic calcification (AAC) was measured by abdomen lateral plain radiograph, and the AAC score was calculated. We identified increased level of MBL and decreased level of C3c and complement factor B compared with normal control. However, C1q, complement factor H, and C4 levels remained at a similar level compared with individuals with normal renal function. The C3a and C5a levels increased, without change of MAC. Forty two of 108 HD patients had the AAC score. C3a levels were correlated with AAC score (r = 0.461, p = 0.002). The median C3a concentration was 238.72 (196.96, 323.41) ng/mL. When evaluated as AAC categories (≤ 4, > 5) with ordinal logistic regression, univariate analyses revealed that higher C3a levels were associated with severe AAC, while multivariate analyses adjusted for age, sex, and calcium level showed that higher C3a levels (OR, 6.28 (1.25–31.69); p = 0.03) were associated with severe AAC. The areas under the curve (AUC) for C3a to diagnose severe abdominal aortic calcification were 0.75(0.58–0.92, 0.01). The complement system was activated in patients on hemodialysis. Higher C3a levels are independently associated with severe AAC. Plasma C3a might have a diagnostic value for the severe AAC in HD patients.

Background: Bioelectrical impedance analysis (BIA) is a promising technique to evaluate dry weight. We compared the dry weight calculated by the three BIA equations Carlo Basile (CB) , Yanna Dou (YD) and the body composition spectroscopy (BCS) with clinical evaluation in maintenance hemodialysis (MHD) patients. Methods: The dry weight of enrolled MHD patients (DWClin) was evaluated under strict clinical surveillance. The whole-body resistances at 50 kHz, intra- and extracellular resistances were measured to calculate the dry weight (DWCB, DWYD and DWBCS) using each of the three equations. Results: Neither DWCB nor DWBCS were statistically different compared to DWClin (DWCB 63.2 ± 17.2 vs. 63.1 ± 16.1 kg; DWBCS 62.8 ± 16.8 vs. 63.1 ± 16.1 kg, p > 0.05). DWYD was significantly lower than DWClin (DWYD 62.0 ± 16.1 vs. 63.1 ± 16.1 kg, p < 0.05). The bias between DWCB and DWClin was the smallest among these three methods (ΔDWCB -0.1 ± 1.4 kg; ΔDWYD 1.1 ± 2.9 kg; ΔDWBCS 0.3 ± 1.8 kg). Conclusion: The CB equations have better consistency with clinical dry weight in MHD patients.

Background: We proposed a new method to estimate dry weight (DW) using single frequency bioimpedance. Methods: We hypothesized that the change in whole body resistance at 50 kHz (R50) was proportional to the ultrafiltration volume (UFV) during a hemodialysis (HD) session. When the targeted resistance estimated in healthy subjects was reached, the patient achieved his/her DW. UFV and R50 were monitored in 40 HD patients. Another 43 HD patients were stratified into 2 groups to validate this method. Results: The change in whole body resistance was proportional to UFV in each of the 40 HD patients. In the DWdecrease group, pre-dialysis systolic blood pressure (n = 29, 154.5 ± 22.8 vs. 146.9 ± 22.3, p < 0.05) and antihypertensive medicine (4.7 ± 3.6 vs. 3.3 ± 2.2, p < 0.05) decreased without adverse symptoms change. In the DWincrease group, the number of adverse symptoms in 1 week (n = 14, 26 vs. 6, p < 0.05) decreased without a change in systolic blood pressure. Conclusion: This method may become a convenient and cheaper way to estimate DW in HD patients.