Kinetics of the metal cations magnesium, calcium, copper, zinc, strontium, barium, and lead in chronic hemodialysis patients.
BACKGROUND
Dialysis patients are at risk of developing trace element imbalances. To further elucidate the origin of these potential trace element imbalances, plasma and dialysis fluids concentrations of the elements barium (Ba), calcium (Ca), copper (Cu), lead (Pb), magnesium (Mg), strontium (Sr) and zinc (Zn) of seven maintenance dialysis patients were investigated.


METHODS
In each hemodialysis session 10 to 15 samples of each, whole blood and dialysis liquid before and after passing the artificial kidney were collected. Concentrations of elements were determined by inductively coupled plasma mass spectrometry following strict quality control schemes to guarantee the accuracy and precision of the results.


RESULTS
Plasma concentrations of Cu and Zn continuously increased during hemodialysis. Plasma Cu remained within the reference range for healthy adults, whereas plasma Zn was always at or below the reference range in our patients. The behavior of Ca and Sr exhibited extraordinarily strong similarities both in plasma and dialysis liquids, although concentrations of Sr are approximately 2000 times lower. Plasma Ca and Sr were at or above the upper level of the reference range. Plasma Mg concentrations decreased during clinical treatment, but were at the end of dialysis still more than 50% higher than the high end of the reference range. Although concentrations of Ba in dialysis fluids were approximately 10 times lower than in plasma, plasma Ba concentrations (approximately 23 microg/l) were significantly elevated compared to plasma Ba of healthy adults. Initial concentrations of Pb in plasma (0.74 microg/l) were increased by approximately 15% during the clinical treatment and were always higher than the high limit of the reference range. Dialysis liquids had approximately the same Pb concentrations (0.5 to 1.3 microg/l) as found in the plasma of our patients but with higher concentrations at the inlet of the dialyzer.


CONCLUSIONS
This study could give an insight into the kinetics of trace element concentrations during dialysis, the clinical relevance of which needs to be further elucidated.
Institute for Analytical Chemistry, Karl Franzens University, Graz, Austria.
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Krachler
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Scharfetter
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Wirnsberger
D000328:Adult; D000368:Aged; D001464:Barium / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D003300:Copper / Q000378:metabolism; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry; D006801:Humans; D007854:Lead / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013324:Strontium / Q000378:metabolism; D014131:Trace Elements / Q000378:metabolism*; D015032:Zinc / Q000378:metabolism
D015312:Hemodialysis Solutions; D014131:Trace Elements; D001464:Barium; D007854:Lead; D003300:Copper; D015032:Zinc; D002118:Calcium; D013324:Strontium