Key result
Reducing dialysis calcium to 2.5 mEq/L is linked to a ~21 mmHg SBP drop without hemodynamic instability.
Why the study?
Hypertension is prevalent in haemodialysis patients and increases cardiovascular risk, but some maintain high blood pressure despite dietary measures, haemodialysis regimen optimization, and pharmacological treatment.
Does decreasing haemodialysis fluid calcium concentration to 2.5 mEq/L reduce blood pressure in hypertensive patients undergoing haemodialysis?
Does decreasing haemodialysis fluid calcium concentration to 2.5 mEq/L reduce blood pressure in hypertensive patients undergoing haemodialysis?
Absolute Event Rate: 141% vs 162%
p-value: p=0.001
Reducing calcium concentration in dialysis fluid to 2.5 mEq/L significantly lowers systolic and diastolic blood pressure in normovolemic hypertensive hemodialysis patients without increasing hemodynamic instability.
Lowering dialysate calcium to 2.5 mEq/L was associated with BP reduction in select hemodialysis patients; leaves open efficacy, safety, and outcomes in randomized trials.
Background Hypertension is a highly prevalent disorder among patients undergoing haemodialysis. It contributes to greater cardiovascular risk and must be controlled. However, despite dietary measures, haemodialysis regimen optimization and pharmacological treatment, some patients in our units continue to maintain high blood pressure levels. The objective of the study is to demonstrate that reducing calcium in dialysis fluid can help treat hypertension patients undergoing haemodialysis. Material and methods We selected all of the hypertensive patients from our haemodialysis unit. We checked their normovolemic status by means of bioimpedance spectroscopy, decreasing the haemodialysis fluid's calcium concentration to 2.5 mEq/L, with a follow-up period of 12 months. Results A total of 24 patients met the non-volume dependent hypertension criteria (age 61 ± 15 years, males 48%, diabetes 43%). A significant systolic and diastolic blood pressure decrease was observed at 6 and 12 months as a result of reducing the dialysis calcium concentration; this was not accompanied by greater hemodynamic instability (baseline systolic blood pressure: 162 ± 14 mmHg; at 6 months: 146 ± 18 mmHg; at 12 months: 141 ± 21 mmHg; p = 0.001) (baseline diastolic blood pressure: 76 ± 14 mmHg; at 6 months: 70 ± 12 mmHg; at 12 months: 65 ± 11 mmHg; p = 0.005). A non-significant increase in plasma parathyroid hormone levels was also found. No side effects were observed. Conclusions Adding 2.5 mEq/L of calcium to dialysis fluid is a safe and effective therapeutic alternative to control hard-to-manage hypertension among haemodialysis patients.
No takes yet. Share an insight, caveat, or question.
Mencía et al. (2019) studied Hypertension in patients undergoing haemodialysis (n=24). Decreasing haemodialysis fluid calcium concentration vs. Baseline was evaluated on Systolic blood pressure at 12 months (p=0.001). Reducing dialysis fluid calcium to 2.5 mEq/L significantly decreased systolic blood pressure from 162 mmHg at baseline to 141 mmHg at 12 months (p=0.001) without greater hemodynamic instability.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: