title: Effects of different dialysate calcium concentrations on intradialysis hemodynamic stability.
abstract: BACKGROUND
  The interplay of correct solute mass balances, such as those of sodium (Na+), potassium (K+) and total calcium (tCa) (Na+MB, K+MB and tCaMB, respectively) with adequate ultrafiltration volumes (VUF) is crucial to achieving hemodynamic stability during hemodialysis (HD).
  
  
  METHODS
  Twenty-two stable anuric uremic patients underwent three 4-hour bicarbonate HD sessions, each with a different dialysate tCa concentration (1.25, 1.375 and 1.50 mmol/L). The GENIUS dialysis system (Fresenius Medical Care, Germany) was used. Volumes of blood and dialysate processed, VUF and dialysate Na+ and K+ concentrations were prescribed to be the same. Hourly measurements of plasma water ionized Ca (Ca++), Na+ and K+ were made, and their trends analyzed. tCaMBs, Na+MBs and K+MBs were determined. Systolic (SBP), diastolic (DBP) blood pressure, mean arterial pressure (MAP) and heart rate (HR) trends during dialysis were analyzed.
  
  
  RESULTS
  Mean hourly plasma water Ca++ concentrations were statistically significantly higher with a dialysate tCa concentration of 1.50 mmol/L. Mean tCaMBs were positive (diffusion gradient from the dialysate to the patient), increasing with increasing dialysate tCa concentrations (+75 ± 122 mg, +182 ± 125 mg, +293 ± 228 mg, respectively). Their difference was statistically significant (p<0.0005). Mean Na+MBs and K+MBs were not statistically significantly different. SBP, DBP, MAP and HR were not statistically significantly different among the 3 treatments.
  
  
  CONCLUSIONS
  These highly controlled experiments showed that hemodynamic stability does not appear to be statistically significantly influenced by any specific dialysate tCa concentration in this peculiar subset of patients.
authors.affiliation: Nephrology and Dialysis Unit, Miulli General Hospital, Acquaviva delle Fonti, Italy. basile.miulli@libero.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Basile
authors.forename: Pasquale
authors.initials: P
authors.lastname: Libutti
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Di Turo
authors.forename: Francesco
authors.initials: F
authors.lastname: Casucci
authors.forename: Nicola
authors.initials: N
authors.lastname: Losurdo
authors.forename: Annalisa
authors.initials: A
authors.lastname: Teutonico
authors.forename: Luigi
authors.initials: L
authors.lastname: Vernaglione
authors.forename: Carlo
authors.initials: C
authors.lastname: Lomonte
mesh_terms: D000328:Adult; D000368:Aged; D001002:Anuria / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure; D001810:Blood Volume; D002118:Calcium / Q000097:blood*; D018592:Cross-Over Studies; D005260:Female; D006339:Heart Rate; D015312:Hemodialysis Solutions / Q000737:chemistry*; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*; D012964:Sodium / Q000097:blood; D014511:Uremia / Q000097:blood / Q000503:physiopathology / Q000628:therapy*
chemical_list: D015312:Hemodialysis Solutions; D012964:Sodium; D011188:Potassium; D002118:Calcium