Low Calcium Dialysate During Hemodialysis and Sudden Cardiac Arrest

Rod Franklin - Medscape Medical News  

November 24, 2010 (Denver, Colorado) — Sudden cardiac arrest (SCA) is the most common cause of death among patients with end-stage renal disease (ESRD) on hemodialysis; it occurs at a rate 30 times greater than in the general population. But research presented here at Renal Week 2010: American Society of Nephrology 43rd Annual Meeting suggests that modifications of dialysate prescriptions, particularly with regard to calcium levels, can help mitigate SCA risk.

The results of the study were also published online September 1 in Kidney International.

In an abstract presented as a follow-up to their 2009 study on alterations of dialysate prescriptions for ESRD patients, researchers from the Duke University Medical Center Division of Nephrology in Durham, North Carolina, reported that reduced calcium dialysate levels are associated with increased risk for SCA, despite published guidelines suggesting that calcium dialysate concentrations be lowered as a means of controlling vascular complications and soft tissue calcification.

Recommendations promulgated by the National Kidney Foundation Kidney Disease Outcome Quality Initiative in 2000 suggested a reduction of calcium dialysate levels to 2.5 mEq/L. The recent Duke University study, led by Patrick H. Pun, MD, showed, however, that such adjustments are likely to worsen the prolongation of QT intervals, which has been acknowledged as a source of increased risk for ventricular tachyarrhythmias and sudden death.

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