Serum calcium increases the incidence of arrhythmias during acetate hemodialysis.

We investigated the occurrence of arrhythmias during maintenance acetate hemodialysis (HD) using a 24-hour continuous electrocardiogram recording system. Three of 22 patients showed augmented increases in both ventricular premature beats and supraventricular premature beats during HD. When we changed the dialysate from one with a Ca2+ concentration of 1.75 mmol/L (3.5 mEq/L), to one with a Ca2+ concentration of 1.25 mmol/L (2.5 mEq/L), the elevation of serum Ca2+ concentration during HD was abolished and the increases in both ventricular premature beats and supraventricular premature beats were significantly decreased. The elevation of serum Ca2+ concentration during HD might induce either extracellular or intracellular increase in Ca2+ concentration in the heart and elicit either reentry- or triggered-activity types of arrhythmias during HD. The present results indicate that the dialysate with a lower Ca2+ concentration is advisable to use in patients with underlying cardiac diseases.