Hemodialysis and minerals in end stage renal disease

Hemodialysis is the most common reliable therapy of renal replacement in Kidney Disease, especially, the end stage renal disease (ESRD), characterized with the complete loss of kidney function, including excretion of wastes and fluids, control of blood acid-base and mineral concentrations. During hemodialysis, kidney roles are restored, by the balance of substances between the dialysis fluid and patients' blood. However, it may cause serious disturbances of some minerals concentrations in patients' blood, like (Zn, Cu, Mg, etc.), if hemodialysis conditions weren't suitable. This review will discuss this major problem that may lead to life threatening complications in ESRD patients, like: cancer, cardiovascular disease, and worsening of kidney function.

A literature review was done, comparing the results of several previous studies published in international scientific journals, about mineral disturbances in ESRD patients undergoing hemodialysis, among different countries in the world. In all mentioned studies blood samples were taken from patients pre and post dialysis, measuring minerals by atomic absorption spectroscopy.

The included studies obtained conflicting results, as some of them showed an increase in some minerals levels in post dialysis patients compared to pre dialysis, like (Zn, Cr), while other studies revealed a decrease in minerals post dialysis, like Mg, whereas, others found no significant differences between pre and post dialysis, like (Cu, Se). This contradiction may be due to the country of the study, environmental pollution, nutritional conditions, as well as, the conditions of hemodialysis, such as the composition of dialysis fluid, which is affected by the source of its water, and its content of minerals. The type of used dialysis membrane and its surface area also have effect on the movement of minerals through it, between the blood and the dialysis fluid.

In order to avoid the disturbances in serum minerals concentrations in ESRD patients, they should be regularly measured pre and post dialysis, doing the appropriate therapeutic procedures, in addition to best controlling of hemodialysis conditions, especially, the mineral content of hemodialysis fluid, in order to keep their balance in patients' blood.