Roy PN, Danziger RS
Dialysate magnesium concentration predicts the occurrence of
intradialytic hypotension
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1496 1996
With all of the work done on dialysate hypotension, one would think
that new insights relating to dialysate composition and hypotensive
side effects would not be forthcoming. Certainly we know that use of
a low calcium dialysate can increase the risk of hypotension, and such
dialysates should probably not be used in the acute setting unless the
patient is frankly hypercalcemic. Magnesium has vasoactive properties
also, however, and changes in blood magnesium concentration during dialysis
may also impact on vascular stability.
Roy and Danziger compared the incidence of hypotension in 78
clinically stable dialysis patients randomly assigned to acetate or
bicarbonate dialysis using a low (0.38 mM) or high (0.75 mM) dialysate
magnesium
concentration. They measured both the maximum change in MAP (DMAP) as
well as the % incidence of dialysis associated hypotension (DAH).
Interestingly, neither DMAP nor DAH differed between acetate and
bicarbonate. However, with both dialysates, DMAP and DAH were
significantly less with the low magnesium dialysates.
Comment: Although this abstract did not receive a "blue
ribbon", in my judgement it was one of the most important presented at
the ASN 1996 in the dialysis field. I remember sitting at a hall in
ASAIO about 16 years ago when Maggiore presented his results re
dialysis hypotension and extracorporeal blood temperature gradients,
where we all wondered "why didn't we we think of that?". The present
abstract may be an insight of similar importance, and especially
should be considered when dialyzing a hypotensive patient in ICU on
pressors. The magnitude of clinical benefit re hypotension in these
"clinically stable" patients (a reduction of hypotensive epidoses by
50%) was huge.
(John T. Daugirdas, M.D., University of IL at Chicago)
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Am Soc Nephrol
Basic hemodialysis :
Complications (acute)
Basic hemodialysis :
(Intermittent) dialysis for ARF