Consequences of Supraphysiological Dialysate Magnesium on Arterial Stiffness, Hemodynamic Profile, and Endothelial Funct
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ORIGINAL RESEARCH
Consequences of Supraphysiological Dialysate Magnesium on Arterial Stiffness, Hemodynamic Profile, and Endothelial Function in Hemodialysis: A Randomized Crossover Study Followed by a NonControlled Follow-Up Phase Rosaria Del Giorno
. Soraya Lavorato Hadjeres . Kevyn Stefanelli .
Giampiero Allegra . Claudia Zapparoli . Lazarevic Predrag . Lorenzo Berwert . Luca Gabutti Received: August 18, 2020 / Accepted: September 12, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Increasing dialysate magnesium (D-Mg2?) appears to be an intriguing strategy to obtain cardiovascular benefits in subjects with end-stage kidney disease (ESKD) on hemodialysis. To date, however, hemodialysis guidelines do not suggest to increase D-Mg2? routinely set at 0.50 mmol/L.
Rosaria Del Giorno and Soraya Lavorato Hadjeres are joint first authors.
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12943172. R. Del Giorno (&) G. Allegra C. Zapparoli L. Gabutti (&) Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland e-mail: [email protected]. Gabutti e-mail: [email protected] S. Lavorato Hadjeres L. Predrag L. Berwert L. Gabutti Nephrology and Dialysis Service, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland K. Stefanelli Department of Social Sciences and Economics, Sapienza University of Rome, Rome, Italy R. Del Giorno L. Gabutti Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
Methods: A randomized 4-week crossover study aimed at investigating the consequences of increasing D-Mg2? from 0.50 to 0.75 mmol/L on arterial stiffness, hemodynamic profile, and endothelial function in subjects undergoing hemodialysis. The long-term effect of higher D-Mg2? on mineral metabolism markers was investigated in a 6-month follow-up. Data were analyzed by linear mixed models for repeated measures. Results: Data of 39 patients were analyzed. Pulse wave velocity and pulse pressure significantly decreased on the higher D-Mg2? compared with the standard one by - 0.91 m/s (95% confidence interval - 1.52 to - 0.29; p = 0.01) and - 9.61 mmHg (- 18.89 to - 0.33, p = 0.04), respectively. A significant reduction in systolic blood pressure of - 12.96 mmHg (- 24.71 to - 1.22, p = 0.03) was also observed. No period or carryover effects were observed. During the long-term follow-up phase the higher D-Mg2? significantly increased ionized and total serum Mg (respectively from 0.54 to 0.64 and from 0.84 to 1.07 mmol/L; mean percentage change from baseline to follow-up ? 21% and ? 27%; p B 0.001), while parathormone (PTH) decreased significantly (from 36.6 to 34.4 pmol/ L; % change - 11%, p = 0.03). Conclusions: Increasing dialysate magnesium improves vascular stiffness in subjects undergoing maintenance hemodialysis. The present findings merit a larger trial to evaluate the
Adv Ther
effects of 0.75 mmol
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