ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2026
Clinical impact of ionized calcium and hidden hypocalcemia on cardiovascular outcomes in dialysis patients.
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
Abstract
backgroundCalcium homeostasis is critical for cardiovascular health in chronic kidney disease (CKD). Ionized calcium is biologically active, but clinical monitoring typically relies on total or albumin-corrected calcium, which may misclassify calcium status and mask abnormalities such as hidden hypocalcemia. We examined the associations of ionized calcium levels and hidden hypocalcemia with cardiovascular outcomes in dialysis patients.
methodsWe analyzed 637 maintenance dialysis patients from the prospective, multicenter ORCHESTRA cohort with ionized calcium measurements at baseline, 6, and 12 months. To minimize reverse causality, patients experiencing events within the first 12 months were excluded from time-to-event analyses. Total, albumin-corrected, and ionized calcium were categorized as low, normal, or high, and patients were further classified into concordant or discordant groups (both normal, hidden hypocalcemia, true hypocalcemia, hidden hypercalcemia, true hypercalcemia). Cox models assessed associations of baseline and longitudinal calcium categories with major adverse cardiovascular events (MACE; cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) and all-cause mortality.
resultsDuring a median follow-up of 1.1 years after the 12-month assessment, 61 MACE and 52 deaths occurred. When evaluated using 12-month averaged values, total, corrected, and ionized calcium categories were not significantly associated with MACE or mortality. However, patients with ≥2 ionized hypocalcemic measurements had a higher risk of MACE (adjusted hazard ratio (HR) 3.62; 95% confidence intervals 1.25-10.46). Hidden hypocalcemia (normal total or corrected calcium with low ionized calcium) was associated with increased MACE risk both at baseline (total × ionized HR 2.94; corrected × ionized HR 2.81) and in longitudinal analyses (corrected × ionized ≥ 2 episodes HR 4.58). No calcium category was associated with mortality.
conclusionsTotal and albumin-corrected calcium were not associated with cardiovascular outcomes. By contrast, recurrent hidden hypocalcemia was associated with excess MACE risk. These findings suggest that evaluating discordance between total and ionized calcium may provide clinically relevant information beyond conventional calcium measures in dialysis patients.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.