TY - JOUR
TI - Dialysate calcium profiling during hemodialysis: Use and clinical
implications
AU - Kyriazis, J
AU - Glotsos, J
AU - Bilirakis, L
AU - Smirnioudis, N and
AU - Tripolitou, M
AU - Georgiakodis, F
AU - Grimani, I
JO - Kidney International
PY - 2002
VL - 61
TODO - 1
SP - 276-287
PB - Blackwell Publishing Inc.
SN - 0085-2538, 1523-1755
TODO - 10.1046/j.1523-1755.2002.00100.x
TODO - hypercalcemia; intradialytic blood pressure; hypotension; hemodynamics;
secondary hyperparathyroidism; end-stage renal disease
TODO - Background. Low dialysate calcium (LdCa) concentration is used to
prevent or treat hemodialysis (HD)-induced hypercalcemia. but its use
has been complicated by intradialytic hypotension in some patients. Our
goal was to explore the possibility that dialysis calcium profiling
(dCaP) can ameliorate intradialytic hypotension in HD patients who need
to have dialysis performed with LdCa.
Methods. In a randomized crossover design. eighteen HD patients
underwent one four-hour HD session with LdCa of 1.25 mmol/L (LdCa group)
and one four-hour HD session with LdCa of 1.25 mmol/L during the first
two hours and high dCa of 1.75 mmol/L during the remaining two hours
(dCaP group). After that. they underwent another four-hour HD session
with medium dCa of 1.5 mmol/L (MdCa group). Before HD and at four
60-minute intervals during the HD sessions, blood pressure (BP), heart
rate (HR) and noninvasive measurements of cardiac index (CI). using
bioelectrical impedance, were obtained. Ionized serum calcium (iCa) also
was measured before HD and at 120 and 240 minutes into the HD session.
In a separate study. eight HD patients were treated for three weeks with
1.25 mmol/L dCa and three weeks with the dCaP technique described above,
in random order. A three-week treatment with MdCa followed. BP and
symptoms were recorded during each HD session.
Results. During the LdCa treatment the iCa values remained unchanged,
whereas mean arterial pressure (MAP) and CI decreased by 16.5 +/- 8.3%
and 14.2 +/- 14.6%. respectively, at the end of HD. During the first
half of the dCaP treatment. iCa, MAP and CI decreased by 2.2 +/- 4.1%,
12.6 +/- 12.3%, and 9.6 +/- 13.4%, respectively. whereas during the
second half of the same treatment. iCa. MAP and CI values increased by
10.2 +/- 3.3%, 7.8 +/- 7.2% and 10.8 +/- 9.1%. respectively, from the
middle HD values. ANOVA showed that the time x treatment effect was
significant for iCa. MAP and CI. Total peripheral resistance and HR
changes were insignificant and similar among treatments. Hemodynamic
effects were comparable between LdCa and MdCa treatments, Intradialytic
events were reduced (P < 0.05) only with the dCaP treatment.
Conclusions. The drop in BP observed during the last two hours of HD in
both the LdCa and MdCa groups was abolished in the dCaP group, The
latter was accomplished via an increase in cardiac output, due to an
iCa-induced increase in myocardial contractility. Therefore, dCaP, by
individualizing the dCa concentrations used and timing the switching
between them, may improve intradialytic BP instability and
simultaneously minimize the risk for HD patients to develop
hypercalcemia.
ER -