Randomized controlled trial of dialysate calcium concentrations on risks of adverse reactions in hemodialysis patients during dialysis

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Objective To explore the effects of dialysate calcium concentrations (DCC) on risks of adverse reactions occurred in maintenance hemodialysis patients during dialysis. Methods The subjects were end-stage renal disease (ESRD) patients in stable condition who were treated with maintenance dialysis in the First Affiliated Hospital, Zhejiang University from June to October 2016. According to the DCC, the patients were randomly divided into 3 groups, the 1.25 mmol/L group, the 1.35 mmol/L group, and the 1.50 mmol/L group; the observation time was 12 weeks. The urea clearance index Kt/V, urea reduction rate (URR), mean arterial pressure before and after dialysis, the serum calcium, serum phosphorus, intact parathyroid hormone (iPTH), and alkaline phosphatase (ALP) levels before and after dialysis, and the incidence of muscle spasm, nausea and vomiting, headache, chest tightness, and arrhythmia in hemodialysis patients in the 3 groups were compared. Results A total of 273 patients entered the study, including 159 males and 114 females with ages from 25 to 83 years and average age of (52±9) years. Each of the 1.25 mmol/L, 1.35 mmol/L, and 1. 50 mmol/L groups comprised 91 patients. The differences of baseline data in patients in the 3 groups were not statistically significant (P>0.05). After 12 weeks of hemodialysis, the differences of Kt/V and URR in patients in the 3 groups were not statistically significant (all P>0.05); the differences of the mean arterial pressures in patients in the 1.25 and 1.35 mmol/L groups [(102±9) and (103±11) mmHg, respectively] were not statistically significant (all P>0.0.5); the mean arterial pressure in the patients in the 1.50 mmol/L group was higher than that before hemodialysis [(120±12) mmHg vs. (103±9) mmHg, P 0.05). Conclusion The dialysate with calcium concentration of 1.35 mmol/L may reduce the incidence of muscle spasm, does not increase the incidence of hypertension and headache, and effectively reduce the risk of adverse reactions in maintenance hemodialysis patients, while ensuring the adequacy of dialysis. Key words: Hemodialysis solutions; Calcium; Drug-related side effects and adverse reactions