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Comparative effects of 1.25 vs. 1.5 mmol/L dialysate calcium concentrations on blood pressure variability during

Daqing Hong1,2,3, Changlian Li4,5, Yun Zhang6

  • 1Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Frontiers in Medicine
|March 30, 2026
PubMed

Insights

Lowering dialysate calcium concentration during hemodialysis significantly reduces blood pressure variability (BPV). This suggests a strategy to improve hemodynamic stability and patient outcomes in dialysis patients.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Clinical Chemistry

Background:

  • Blood pressure fluctuations in hemodialysis patients are linked to adverse cardiovascular events.
  • The optimal dialysate calcium concentration for managing blood pressure variability (BPV) is debated.

Purpose of the Study:

  • To compare the effects of two dialysate calcium concentrations (1.25 mmol/L vs. 1.5 mmol/L) on intradialytic blood pressure variability.
  • To identify the optimal dialysate calcium concentration for minimizing BPV in hemodialysis patients.

Main Methods:

  • Retrospective cohort study analyzing 2,061 hemodialysis sessions from 711 patients.
  • Patients were divided into two groups based on dialysate calcium: 1.25 mmol/L (n=473) and 1.5 mmol/L (n=238).
  • Blood pressure variability was defined as the difference between maximum and minimum blood pressure during dialysis.

Main Results:

  • The 1.25 mmol/L group showed significantly lower systolic (SBPV), diastolic (DBPV), and mean arterial pressure variability (MAPV) compared to the 1.5 mmol/L group (p < 0.001 for all).
  • Smaller serum total calcium changes occurred in the 1.25 mmol/L group, correlating positively with SBPV and MAPV.
  • Higher dialysate calcium (1.5 mmol/L) was independently associated with greater BPV after adjusting for confounders.

Conclusions:

  • Lowering dialysate calcium concentration to 1.25 mmol/L may enhance hemodynamic stability during hemodialysis.
  • Minimizing calcium flux through lower dialysate calcium concentrations could reduce blood pressure fluctuations.
Abstract

Keywords:
blood pressure variabilitycalcium concentrationcalcium fluxdialysate calciumhemodialysis

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