High magnesium dialysate does not improve intradialytic hemodynamics or abrogate myocardial stunning.
Hemodialysis
cardiac stunning
magnesium
Journal
Hemodialysis international. International Symposium on Home Hemodialysis
ISSN: 1542-4758
Titre abrégé: Hemodial Int
Pays: Canada
ID NLM: 101093910
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
09
03
2020
revised:
14
07
2020
accepted:
15
07
2020
pubmed:
28
8
2020
medline:
20
3
2021
entrez:
27
8
2020
Statut:
ppublish
Résumé
Hemodialysis (HD) induces myocardial stunning and is associated with adverse cardiovascular outcomes. Intradialytic hypotension is a modifiable determinant of myocardial stunning. Magnesium (Mg) is reported to be valuable in maintaining intradialytic blood pressure, which potentially would protect against demand myocardial ischemia. This study aimed to compare high vs. low dialysate Mg effects on intradialytic hemodynamics and HD-induced myocardial stunning. Twenty stable prevalent HD patients entered a randomized cross-over trial of low (0.5 mmol/L) vs. high (1.0 mmol/L) dialysate Mg. Patients were studied after 2 weeks of standard HD with each Mg concentration. Serial echocardiography assessed myocardial stunning, measured by left ventricular regional wall motion abnormalities (RWMAs). Continuous intradialytic hemodynamics were measured noninvasively using thoracic bioimpedance. Median predialysis serum Mg was higher with high dialysate Mg (1.45[1.29-1.55] vs. 1.03[0.98-1.1] mmol/L, P < 0.0001). There was no significant difference in maximum intradialytic reduction in systolic BP. There was no significant difference in stroke volume, total peripheral resistance, and cardiac output. Overall ventricular global longitudinal strain (GLS) (as a sensitive marker of contractile function) was higher before dialysis in high Mg group, but there was no difference in GLS at peak stress. However, we showed a significant correlation between Mg changes and GLS changes, r = -0.47, P = 0.02. There was no difference in mean number of peak stress RWMAs per patient (4.0 ± 2.2 vs. 4.3 ± 2.9, P = 0.5). Ultrafiltration volume, a critical determinant of stunning, was not different between high and low dialysate Mg studies (1.35[0-3.3] vs. 1.5[0-2.8], P = 0.49). Manipulation of magnesium by altering dialysate magnesium concentration does not influence intradialytic hemodynamic response or HD-induced myocardial stunning in the short term. However, decreasing Mg changes appears to decrease GLS changes.
Sections du résumé
BACKGROUND
Hemodialysis (HD) induces myocardial stunning and is associated with adverse cardiovascular outcomes. Intradialytic hypotension is a modifiable determinant of myocardial stunning. Magnesium (Mg) is reported to be valuable in maintaining intradialytic blood pressure, which potentially would protect against demand myocardial ischemia. This study aimed to compare high vs. low dialysate Mg effects on intradialytic hemodynamics and HD-induced myocardial stunning.
METHODS
Twenty stable prevalent HD patients entered a randomized cross-over trial of low (0.5 mmol/L) vs. high (1.0 mmol/L) dialysate Mg. Patients were studied after 2 weeks of standard HD with each Mg concentration. Serial echocardiography assessed myocardial stunning, measured by left ventricular regional wall motion abnormalities (RWMAs). Continuous intradialytic hemodynamics were measured noninvasively using thoracic bioimpedance.
FINDINGS
Median predialysis serum Mg was higher with high dialysate Mg (1.45[1.29-1.55] vs. 1.03[0.98-1.1] mmol/L, P < 0.0001). There was no significant difference in maximum intradialytic reduction in systolic BP. There was no significant difference in stroke volume, total peripheral resistance, and cardiac output. Overall ventricular global longitudinal strain (GLS) (as a sensitive marker of contractile function) was higher before dialysis in high Mg group, but there was no difference in GLS at peak stress. However, we showed a significant correlation between Mg changes and GLS changes, r = -0.47, P = 0.02. There was no difference in mean number of peak stress RWMAs per patient (4.0 ± 2.2 vs. 4.3 ± 2.9, P = 0.5). Ultrafiltration volume, a critical determinant of stunning, was not different between high and low dialysate Mg studies (1.35[0-3.3] vs. 1.5[0-2.8], P = 0.49).
DISCUSSION
Manipulation of magnesium by altering dialysate magnesium concentration does not influence intradialytic hemodynamic response or HD-induced myocardial stunning in the short term. However, decreasing Mg changes appears to decrease GLS changes.
Substances chimiques
Dialysis Solutions
0
Magnesium
I38ZP9992A
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
506-515Informations de copyright
© 2020 International Society for Hemodialysis.
Références
McIntyre CW. Recurrent circulatory stress: The dark side of dialysis. Semin Dial. 2010;23:449-451. https://doi.org/10.1111/j.1525-139X.2010.00782.x.
Jefferies HJ, Burton JO, McIntyre CW. Individualised dialysate temperature improves intradialytic haemodynamics and abrogates haemodialysis-induced myocardial stunning, without compromising tolerability. Blood Purif. 2011;32:63-68. https://doi.org/10.1159/000324199.
Leenders NHJ, van Ittersum FJ, Hoekstra T, Hoenderop JGJ, Vervloet MG. Routine hemodialysis induces a decline in plasma magnesium concentration in most patients: A prospective observational cohort study. Sci Rep. 2018;8:10256. https://doi.org/10.1038/s41598-018-28629-x.
Reffelmann T, Dörr M, Ittermann T, et al. Low serum magnesium concentrations predict increase in left ventricular mass over 5 years independently of common cardiovascular risk factors. Atherosclerosis. 2010;213:563-569. https://doi.org/10.1016/j.atherosclerosis.2010.08.073.
Reffelmann T, Ittermann T, Dörr M, et al. Low serum magnesium concentrations predict cardiovascular and all-cause mortality. Atherosclerosis. 2011;219:280-284. https://doi.org/10.1016/j.atherosclerosis.2011.05.038.
de Roij van Zuijdewijn CLM, Grooteman MPC, Bots ML, et al. Serum magnesium and sudden death in European hemodialysis patients. PLoS One. 2015;10:e0143104. https://doi.org/10.1371/journal.pone.0143104.
Sakaguchi Y, Fujii N, Shoji T, et al. Magnesium modifies the cardiovascular mortality risk associated with hyperphosphatemia in patients undergoing hemodialysis: A cohort study. PLoS One. 2014;9:e116273. https://doi.org/10.1371/journal.pone.0116273.
Lacson E, Wang W, Ma L, Passlick-Deetjen J. Serum magnesium and mortality in hemodialysis patients in the United States: A cohort study. Am J Kidney Dis Off J Natl Kidney Found. 2015;66:1056-1066. https://doi.org/10.1053/j.ajkd.2015.06.014.
Elsharkawy MM, Youssef AM, Zayoon MY. Intradialytic changes of serum magnesium and their relation to hypotensive episodes in hemodialysis patients on different dialysates. Hemodial Int Int Symp Home Hemodial. 2006;10:S16-S23. https://doi.org/10.1111/j.1542-4758.2006.00120.x.
Kyriazis J, Kalogeropoulou K, Bilirakis L, et al. Dialysate magnesium level and blood pressure. Kidney Int. 2004;66:1221-1231. https://doi.org/10.1111/j.1523-1755.2004.00875.x.
Squara P, Denjean D, Estagnasie P, Brusset A, Dib JC, Dubois C. Noninvasive cardiac output monitoring (NICOM): A clinical validation. Intensive Care Med. 2007;33:1191-1194. https://doi.org/10.1007/s00134-007-0640-0.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233-270. https://doi.org/10.1093/ehjci/jev014.
Schneditz D, Putz-Bankuti C, Ribitsch W, Schilcher G. Correction of plasma concentrations for effects of hemoconcentration or hemodilution. ASAIO J Am Soc Artif Intern Organs. 2012;58:160-162. https://doi.org/10.1097/MAT.0b013e318243660f.
Bressendorff I, Hansen D, Schou M, Pasch A, Brandi L. The effect of increasing dialysate magnesium on serum calcification propensity in subjects with end stage kidney disease: A randomized, controlled clinical trial. Clin J Am Soc Nephrol CJASN. 2018;13:1373-1380. https://doi.org/10.2215/CJN.13921217.
Schmaderer C, Braunisch MC, Suttmann Y, et al. Reduced mortality in maintenance haemodialysis patients on high versus low dialysate magnesium: A pilot study. Nutrients. 2017;9:926. https://doi.org/10.3390/nu9090926.
Küchle C, Suttmann Y, Reichelt A-L, Apfelböck J, Zoller V, Heemann U. Correcting low magnesia levels in hemodialysis by higher dialysate magnesium. Cogent Med. 2017;4:1-19. https://doi.org/10.1080/2331205X.2017.1302544.
Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: Determinants and associated outcomes. Clin J Am Soc Nephrol. 2009;4:914-920. https://doi.org/10.2215/CJN.03900808.
Kraus F. Reversal of diastolic dysfunction by intravenous magnesium chloride. Can J Cardiol. 1993;9:618-620.
Kolte D, Vijayaraghavan K, Khera S, Sica DA, Frishman WH. Role of magnesium in cardiovascular diseases. Cardiol Rev. 2014;22:182-192. https://doi.org/10.1097/CRD.0000000000000003.
Wu W-C, Huang M, Taveira TH, et al. Relationship between dietary magnesium intake and incident heart failure among older women: The WHI. J Am Heart Assoc. 2020;9:e013570. https://doi.org/10.1161/JAHA.119.013570.
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. 2007;20:237-244.
João Matias P, Azevedo A, Laranjinha I, et al. Lower serum magnesium is associated with cardiovascular risk factors and mortality in haemodialysis patients. Blood Purif. 2014;38:244-252. https://doi.org/10.1159/000366124.
Selim GN, Spasovski G, Tozija L, et al. Hypomagnesemia and cause-specific mortality in hemodialysis patients: 5-year follow-up analysis. Int J Artif Organs. 2017;40:542-549. https://doi.org/10.5301/ijao.5000611.
Tumlin JA, Roy-Chaudhury P, Koplan BA, et al. MiD investigators and committees (2019) relationship between dialytic parameters and reviewer confirmed arrhythmias in hemodialysis patients in the monitoring in dialysis study. BMC Nephrol. 2019;20:80. https://doi.org/10.1186/s12882-019-1212-6.
Malpuech-Brugère C, Nowacki W, Daveau M, et al. Inflammatory response following acute magnesium deficiency in the rat. Biochim Biophys Acta. 2000;1501:91-98. https://doi.org/10.1016/s0925-4439(00)00018-1.
Bussière FI, Gueux E, Rock E, et al. Increased phagocytosis and production of reactive oxygen species by neutrophils during magnesium deficiency in rats and inhibition by high magnesium concentration. Br J Nutr. 2002;87:107-113. https://doi.org/10.1079/BJN2001498.
Bressendorff I, Hansen D, Pasch A, et al. The effect of increasing dialysate magnesium on calciprotein particles, inflammation and bone markers: Post hoc analysis from a randomized controlled clinical trial. Nephrol Dial Transplant. 2019. https://doi.org/10.1093/ndt/gfz234.