{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:57:48Z","timestamp":1790841468595,"version":"4.1.0"},"reference-count":70,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Dialysate calcium (DCa) and magnesium (DMg) and the organic acid used in the acid concentrate have a profound combined influence on intradialytic mineral balance and may influence vascular calcification progression and treatment-related symptoms. Whereas Kidney Disease: Improving Global Outcomes recommends a DCa between 1.25 (DCa 1.25) and 1.50\u00a0mmol\/l (DCa 1.50), the optimal DCa for an individual patient remains uncertain.<\/jats:p>\n                  <jats:p>No consistent mortality difference between DCa 1.50 and 1.25 has been observed. However, DCa 1.50 may induce a positive calcium balance, raising concerns about vascular calcification progression. Conversely, DCa below 1.25\u00a0mmol\/l has been associated with a higher risk of sudden cardiac death. Compared with acetic acid (acetate dialysate, Acet-D), citric acid (citrate dialysate, Cit-D) reduces calcification propensity of serum, although the effect on vascular calcification progression is inconclusive.<\/jats:p>\n                  <jats:p>Whenever feasible, DCa should be individualized, ideally using estimates of calcium mass balance (CaMB). Because Cit-D generally results in a more negative CaMB than Acet-D solutions at the same nominal DCa, this difference should be considered when prescribing DCa. Increasing DMg from 0.50 to 0.75\u00a0mmol\/l may improve surrogate cardiovascular outcomes although its effect on clinical outcomes remains to be defined.<\/jats:p>\n                  <jats:p>Overall, Acet-D with DCa 1.25 is a reasonable standard especially when using calcium-containing phosphate binders and in patients at risk for adynamic bone disease, whereas in patients with a high risk of sudden cardiac death, frequent intradialytic hypotension or with severe secondary hyperparathyroidism, DCa 1.50 may be a reasonable alternative. Regarding the choice of acid, the use of Cit-D represents a promising alternative pending further clinical evidence.<\/jats:p>","DOI":"10.1093\/ckj\/sfag313","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:13:30Z","timestamp":1789384410000},"source":"Crossref","is-referenced-by-count":0,"title":["The effects of dialysate acids and divalent ions on calcification and cardiovascular outcomes: old wisdom and new developments"],"prefix":"10.1093","volume":"19","author":[{"given":"Jeroen P","family":"Kooman","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center , Maastricht ,","place":["the Netherlands"]},{"name":"NUTRIM Research Institute, Maastricht University , Maastricht ,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karlien J","family":"ter\u00a0Meulen","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center , Maastricht ,","place":["the Netherlands"]},{"name":"NUTRIM Research Institute, Maastricht University , Maastricht ,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kotanko","sequence":"additional","affiliation":[{"name":"Renal Research Institute , New York ,","place":["USA"]},{"name":"Icahn School of Medicine at Mount Sinai , New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Canaud","sequence":"additional","affiliation":[{"name":"School of Medicine, Montpellier University , Montpellier ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"2026100103170577900_bib1","doi-asserted-by":"publisher","first-page":"e0151508","DOI":"10.1371\/journal.pone.0151508","article-title":"High-flux 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