Dialysate Composition for Hemodialysis: Changes and Changing Risk

Overview

Journal Semin Dial

Specialty Nephrology

Date 2017 Jan 10

PMID 28066927

Citations 14

Authors

Rita L McGill

Daniel E Weiner

Affiliations

Soon will be listed here.

Abstract

Dialysate composition is a critical aspect of the hemodialysis prescription. Despite this, trial data are almost entirely lacking to help guide the optimal dialysate composition. Often, the concentrations of key components are chosen intuitively, and dialysate composition may be determined by default based on dialysate manufacturer specifications or hemodialysis facility practices. In this review, we examine the current epidemiological evidence guiding selection of dialysate bicarbonate, calcium, magnesium, and potassium, and identify unresolved issues for which pragmatic clinical trials are needed.

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References

Pun P, Horton J, Middleton J . Dialysate calcium concentration and the risk of sudden cardiac arrest in hemodialysis patients. Clin J Am Soc Nephrol. 2013; 8(5):797-803. PMC: 3641623. DOI: 10.2215/CJN.10000912. View

Spiegel D, Farmer B . Long-term effects of magnesium carbonate on coronary artery calcification and bone mineral density in hemodialysis patients: a pilot study. Hemodial Int. 2009; 13(4):453-9. DOI: 10.1111/j.1542-4758.2009.00364.x. View

Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J . US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2015; 66(1 Suppl 1):Svii, S1-305. PMC: 6643986. DOI: 10.1053/j.ajkd.2015.05.001. View

Gennari F . Acid-Base Status and Mortality Risk in Hemodialysis Patients. Am J Kidney Dis. 2015; 66(3):383-5. DOI: 10.1053/j.ajkd.2015.06.008. View

Kraut J, Kurtz I . Metabolic acidosis of CKD: diagnosis, clinical characteristics, and treatment. Am J Kidney Dis. 2005; 45(6):978-93. DOI: 10.1053/j.ajkd.2005.03.003. View

Genovesi S, Rossi E, Nava M, Riva H, DE Franceschi S, Fabbrini P . A case series of chronic haemodialysis patients: mortality, sudden death, and QT interval. Europace. 2013; 15(7):1025-33. DOI: 10.1093/europace/eus412. View

Packham D, Rasmussen H, Lavin P, El-Shahawy M, Roger S, Block G . Sodium zirconium cyclosilicate in hyperkalemia. N Engl J Med. 2014; 372(3):222-31. DOI: 10.1056/NEJMoa1411487. View

Haris A, Sherrard D, Hercz G . Reversal of adynamic bone disease by lowering of dialysate calcium. Kidney Int. 2006; 70(5):931-7. DOI: 10.1038/sj.ki.5001666. View

Langote A, Ahearn M, Zimmerman D . Dialysate Calcium Concentration, Mineral Metabolism Disorders, and Cardiovascular Disease: Deciding the Hemodialysis Bath. Am J Kidney Dis. 2015; 66(2):348-58. DOI: 10.1053/j.ajkd.2015.02.336. View

10.

de Brito-Ashurst I, Varagunam M, Raftery M, Yaqoob M . Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol. 2009; 20(9):2075-84. PMC: 2736774. DOI: 10.1681/ASN.2008111205. View

11.

Kovesdy C, Regidor D, Mehrotra R, Jing J, McAllister C, Greenland S . Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2007; 2(5):999-1007. DOI: 10.2215/CJN.04451206. View

12.

Flythe J, Mc Causland F . Dialysate Sodium: Rationale for Evolution over Time. Semin Dial. 2017; 30(2):99-111. PMC: 5334180. DOI: 10.1111/sdi.12570. View

13.

Heguilen R, Sciurano C, Bellusci A, Fried P, Mittelman G, Rosa Diez G . The faster potassium-lowering effect of high dialysate bicarbonate concentrations in chronic haemodialysis patients. Nephrol Dial Transplant. 2005; 20(3):591-7. DOI: 10.1093/ndt/gfh661. View

14.

Palmer S, McGregor D, Craig J, Elder G, Macaskill P, Strippoli G . Vitamin D compounds for people with chronic kidney disease requiring dialysis. Cochrane Database Syst Rev. 2009; (4):CD005633. DOI: 10.1002/14651858.CD005633.pub2. View

15.

Ishimura E, Okuno S, Yamakawa T, Inaba M, Nishizawa Y . Serum magnesium concentration is a significant predictor of mortality in maintenance hemodialysis patients. Magnes Res. 2008; 20(4):237-44. View

16.

Spasovski G, Gelev S, Masin-Spasovska J, Selim G, Sikole A, Vanholder R . Improvement of bone and mineral parameters related to adynamic bone disease by diminishing dialysate calcium. Bone. 2007; 41(4):698-703. DOI: 10.1016/j.bone.2007.06.014. View

17.

Bakris G, Pitt B, Weir M, Freeman M, Mayo M, Garza D . Effect of Patiromer on Serum Potassium Level in Patients With Hyperkalemia and Diabetic Kidney Disease: The AMETHYST-DN Randomized Clinical Trial. JAMA. 2015; 314(2):151-61. DOI: 10.1001/jama.2015.7446. View

18.

Sakaguchi Y, Fujii N, Shoji T, Hayashi T, Rakugi H, Isaka Y . Hypomagnesemia is a significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis. Kidney Int. 2013; 85(1):174-81. DOI: 10.1038/ki.2013.327. View

19.

Sargent J, Gotch F, Lam M, Prowitt M, Keen M . Technical aspects of on-line proportioning of bicarbonate dialysate. Proc Clin Dial Transplant Forum. 1977; 7:109-16. View

20.

Vashistha T, Kalantar-Zadeh K, Molnar M, Torlen K, Mehrotra R . Dialysis modality and correction of uremic metabolic acidosis: relationship with all-cause and cause-specific mortality. Clin J Am Soc Nephrol. 2012; 8(2):254-64. PMC: 3562859. DOI: 10.2215/CJN.05780612. View