Does a higher dialysate calcium concentration (1.75 mmol/L) worsen left ventricular global longitudinal strain compared to a lower concentration (1.25 mmol/L) in patients on haemodialysis?
In patients on haemodialysis, a higher dialysate calcium concentration (1.75 mmol/L) is associated with worse left ventricular global longitudinal strain compared to a lower concentration (1.25 mmol/L).
Dialysate calcium concentration (dCa) might have a cardiovascular impact in patients on haemodialysis (HD) since a higher dCa determines better hemodynamic tolerability. We have assessed the influence of dCa on global longitudinal strain (GLS) by two-dimensional echocardiography using speckle-tracking imaging before and in the last hour of HD. This is an observational crossover study using dCa 1.75 mmol/L and 1.25 mmol/L. Ultrafiltration was the same between interventions; patients aged 44 ± 13 years (N = 19). The 1.75 mmol/L dCa was associated with lighter drop of blood pressure. Post HD serum total calcium was higher with dCa 1.75 than with 1.25 mmol/L (11.5 ± 0.8 vs. 9.1 ± 0.5 mg/dL, respectively, p < 0.01). In almost all segments strain values were significantly worse in the peak HD with 1.75 mmol/L dCa than with 1.25 mmol/L dCa. GLS decreased from -19.8 ± 3.7% at baseline to -17.3 ± 2.9% and -16.1 ± 2.6% with 1.25 dCa and 1.75 dCa mmol/L, respectively (p < 0.05 for both dCa vs. baseline and 1.25 dCa vs. 1.75 dCa mmol/L). Factors associated with a worse GLS included transferrin, C-reactive protein, weight lost, and post dialysis serum total calcium. We concluded that dCa of 1.75 mmol/L was associated with higher post dialysis serum calcium, which contributed to a worse ventricular performance. Whether this finding would lead to myocardial stunning needs further investigation.
Silva et al. (Wed,) studied this question.
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