Dialysate magnesium level and blood pressure

被引:67
作者
Kyriazis, J [1 ]
Kalogeropoulou, K
Bilirakis, L
Smirnioudis, N
Pikounis, V
Stamatiadis, D
Liolia, E
机构
[1] Gen Hosp Chios, Dialysis Unit, Dept Nephrol, Chios 82100, Greece
[2] Gen Hosp Chios, Dept Internal Med, Chios 82100, Greece
[3] NIMTS Hosp, Dept Nucl Med, Athens, Greece
[4] Gen Hosp Chios, Dept Cardiol, Chios 82100, Greece
[5] Gen Hosp Chios, Dept Chem, Chios 82100, Greece
[6] Laikon Gen Hosp, Dept Nephrol, Athens, Greece
关键词
blood pressure; calcium; dialysate; hemodialysis; hemodynamics; magnesium;
D O I
10.1111/j.1523-1755.2004.00875.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background. We investigated the way dialysate magnesium (dMg) concentrations could affect blood pressure ( BP) during hemodialysis (HD). Methods. Eight HD patients underwent four midweek HD treatments consecutively, using, during each four-hour HD session, one of the following four dialysate formulations, in randomized order, which differed only with regard to dMg and dialysate calcium (dCa) concentrations (in mmol/L): 0.75 dMg, 1.75 dCa (group I); 0.25 dMg, 1.75 dCa (group II); 0.75 dMg, 1.25 dCa (group III); 0.25 dMg, 1.25 dCa (group IV). Before HD and at four 60-minute intervals during the HD sessions, BP and noninvasive measurements of cardiac index (CI) were obtained. Additionally, 14 HD patients were treated for four weeks with 0.5 mmol/L dMg, followed by four weeks with 0.25 mmol/L dMg, and another four weeks with 0.75 mmol/L dMg, in random order. In all treatments dCa was 1.25 mmol/L. BP and symptoms were recorded during each HD session. Results. Mean arterial pressure (MAP) decreased to a significantly (P < 0.05) greater extent in group IV compared to the other groups. This substantial drop in MAP by 15.2% in group IV, paralleled by a 12.1% and 17% drop in CI and stroke index, respectively, was not seen in group II, despite comparable reductions in intradialytic serum Mg (sMg) of about 35% in both groups. In groups I and III, the increase in sMg by 2% did not compromise BP via vasodilatation. In the second study, treatment with 0.75 mmol/L dMg was superior to the other two treatments regarding intradialytic morbidity (P < 0.001) and BP stability (P < 0.05). Conclusion. We (1) identified a dialysis solution containing 0.25 mmol/L Mg and 1.25 mmol/L Ca as a major cause of intradialytic hypotension (IDH) due to an impairment of myocardial contractility, and (2) showed that increasing dMg level to 0.75 mmol/L could prevent IDH frequently seen with the use of 1.25 mmol/L dCa. Thus, manipulating dMg levels independently or in concert with dCa levels might have important implications with regard to dialysis tolerance.
引用
收藏
页码:1221 / 1231
页数:11
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