The Influence of Low Calcium Concentration Hemodialysis on Cardiovascular Response

Kim, Chahyun; Oh, Dongjin; Yoo, Soojeong; Lee, Taewoo; Choi, Jaeyoung; Lee, Kwangje; Kim, Sangwook; Yoo, Sukhee; Kang, Eungtaek

Abstract

OBJECTIVE
Arterial compliance (AC) reflects the buffering function of the vessel. Low AC caused by arterial stiffness increases pulse pressure amplitude. Therefore, Low AC must be correlated with high cardiovascular mobidity and mortality in HD patients. Dialysate calcium concentration is potentially a main determinant of serum ionized calcium level and the vasoconstriction is associated with high calcium concentration. Therefore, We conducted a study for evaluation of the interdialytic effects of treatment with a low dialysate calcium (LdCa) concentration and high dialysate calcium (HdCa) concentration on the changes of AC, BP, biochemical parameters.
METHODS
Eight HD patient (mean age 45.5, sex ratio 1 : 1) were studied. The mean HD period was 3 years. Arterial Compliance, stroke Volume, SBP, DBP, PP, MAP, Ionized Ca, T-CO2, P and CaxP product were compared after treatment with a LdCa and HdCa concentration for each 10 sessions.
RESULTS
AC were 0.143+/-0.076 mm2/kPa in baseline, 0.166+/-0.097 mm2/kPa in LdCa (1.25 mmol/L) dialysate, 0.142+/-0.082 mm2/kPa in HdCa (1.75 mmol/L) dialysate. SBP, DBP, MAP and PP were 157.75+/-15.97, 94.25+/-9.48, 114.12+/-10.56, 63.50+/-10.87 mmHg in baseline and 135.25+/-13.00, 78.75+/-11.24, 98.37+/-15.14, 56.50+/-5.95 mmHg in LdCa dialysate and 160.50+/-15.36, 94.05+/-10.34, 115.75+/-9.64, 62.00+/-15.71 mmHg in HdCa dialysate. Ionized Ca were 4.66+/-0.40 mg/dL in baseline, 4.45+/-0.28 mg/dL in LdCa dialysate and 4.65+/-0.43 mg/dL in HdCa dialysate. However, there were no changes of other biochemical parameters.
CONCLUSION
Treatment with LdCa dialysis, by minimizing the risk for LdCa-induced hypocalcemia, may have a beneficial role in the prevention of the ongoing reduction of arterial compliance in HD patients and thus improve cardiovascular prognosis.