van Kuijk WHM, Mulder AQ, Harff GA, Leunissen KML
The effect of changes in plasma ionized calcium on blood
pressure and vascular reactivity during UF + HD
International Society of Blood Purification
Blood Purif
(Sep) 13:(supp.1)53 1995
The trend is to utilize calcium salts as phosphate binders and pulse oral or
iv calcitriol to
suppress PTH. The consequence is hypercalcemia, which is countered by a low
calcium
dialysate. This is also problematic because calcium ions are crucial to
myocardial contractility
and may be involved in peripheral vascular smooth muscle tone.
To test the role of low calcium dialysate in intradialytic hemodynamics,
forearm vascular
resistance and venous tone were measured in 10 hemodialysis patents
undergoing dialysis with
1.25 and 1.75 mmol/l calcium dialysate. The ultrafiltration rate was 800
ml/hr. Plasma ionized
calcium did not vary from baseline with 1.25 mmol/l dialysate but
significantly rose with 1.75
mmol/l dialysate. Mean and systolic BP fell only during low calcium
dialysis. Venous tone
decreased and vascular resistance increased equally during both dialysate
exposures. By
echocardiogram stroke volume, cardiac output and cardiac index all fell only
with low calcium
dialysate. Plasma [norepi] rose during high calcium dialysis.
Thus the adverse hemodynamic effects of low calcium dialysate appear to be
mediated by direct
cardiac effects rather than peripheral vascular effects. Furthermore,
[norepi] may be dependent
on the hypercalcemia noted during high calcium dialysis.
(T.A. Golper)
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International Society of Blood Purification
Basic hemodialysis :
Complications (acute)