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Hemodialysis with high-calcium dialysate impairs cardiac relaxation
S E Näppi1, H H Saha, V K Virtanen
1University of Tampere, Medical School, Tampere, Finland.
Insights
High-calcium hemodialysis (HD) impairs left ventricular (LV) relaxation. This study found that using a dialysate calcium concentration of 1.75 mmol/liter during HD significantly worsened LV relaxation compared to lower concentrations.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Serum ionized calcium levels correlate with dialysate calcium concentration during hemodialysis (HD).
- Previous research indicated that acute hypercalcemia can impair left ventricular (LV) relaxation.
- The study investigated the impact of serum calcium changes on LV function during HD.
Purpose of the Study:
- To determine if varying dialysate calcium concentrations during HD affect LV relaxation and systolic function.
- To assess the relationship between dialysate calcium levels and serum ionized calcium in end-stage renal disease (ESRD) patients.
Main Methods:
- Echocardiographic evaluation of LV relaxation and systolic function in 12 ESRD patients.
- Patients underwent three HD treatments with varying dialysate calcium concentrations (1.25, 1.50, and 1.75 mmol/liter).
- Comparison with age- and sex-matched healthy controls.
Main Results:
- Patients exhibited impaired LV relaxation and systolic function compared to controls.
- Serum ionized calcium increased significantly during HD with 1.50 and 1.75 mmol/liter dialysate calcium.
- LV relaxation was significantly impaired during HD with 1.75 mmol/liter dialysate calcium (higher concentration).
Conclusions:
- Hemodialysis using a high-calcium dialysate (1.75 mmol/liter) negatively impacts LV relaxation.
- Lower dialysate calcium concentrations (1.25 and 1.50 mmol/liter) did not show the same degree of impairment.
- Dialysate calcium levels should be carefully managed during HD to protect cardiac function.
Background:
During hemodialysis (HD), serum ionized calcium is directly related to the dialysate calcium concentration. We have recently shown an acute induction of hypercalcemia to impair left ventricular (LV) relaxation. In the current study we sought to establish whether changes in serum Ca++ also affect LV function during HD.
Methods:
We echocardiographically examined the LV relaxation and systolic function of 12 patients with end-stage renal disease before and after three HD treatments with dialysate Ca++ concentrations of 1.25 mmol/liter (dCa++1.25), 1.5 mmol/liter (dCa++1.50), and 1.75 mmol/liter (dCa++1.75), respectively. Age- and sex-matched healthy controls were also examined echocardiographically.
Results:
The LV posterior wall thickness and the interventricular septum thickness, and the LV end-diastolic dimension and the end-systolic dimensions were significantly greater in the patients when compared with the controls, and the LV fractional shortening, the ratio of peak early to peak late diastolic velocities (E/Amax), and the isovolumic relaxation time (IVRT) showed impairment of LV relaxation and systolic function in the patients. Serum ionized calcium increased significantly during the dCa++1.5 HD (1.24 +/- 0.10 vs. 1.34 +/- 0.06 mmol/liter, P = 0. 004) and dCa++1.75 HD (1.19 +/- 0.10 vs. 1.47 +/- 0.06 mmol/liter, P = 0.002), and plasma intact parathyroid hormone decreased significantly during the dCa++1.75 HD (medians 8.2 vs. 2.7 pmol/liter, P = 0.002). LV systolic function was not altered during any of the treatments. The changes in E/Amax and IVRT suggested impairment of relaxation during all sessions, but only during the dCa++1.75 HD was the impairment statistically significant (E/Amax 1. 153 +/- 0.437 vs. 0.943 +/- 0.352, P < 0.05; IVRT 147 +/- 29 vs. 175 +/- 50 msecond, P < 0.05).
Conclusion:
HD with high-calcium (dCa++1. 75 mmol/liter) dialysate impairs LV relaxation when compared with lower calcium dialysate (dCa++1.25 and dCa++1.5 mmol/liter) treatments.