在血液透析中，超生理透析液镁对动脉僵硬度、血液动力学特征和内皮功能的影响：一项随机交叉研究及随后的非对照随访阶段。

Consequences of Supraphysiological Dialysate Magnesium on Arterial Stiffness, Hemodynamic Profile, and Endothelial Function in Hemodialysis: A Randomized Crossover Study Followed by a Non-Controlled Follow-Up Phase.

机构信息

Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.

Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland.

出版信息

Adv Ther. 2020 Dec;37(12):4848-4865. doi: 10.1007/s12325-020-01505-9. Epub 2020 Sep 29.

DOI:10.1007/s12325-020-01505-9

PMID:32996010

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7595984/

Abstract

INTRODUCTION

Increasing dialysate magnesium (D-Mg) 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-Mg routinely set at 0.50 mmol/L.

METHODS

A randomized 4-week crossover study aimed at investigating the consequences of increasing D-Mg 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-Mg 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-Mg 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-Mg 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 ≤ 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 effects of 0.75 mmol/L D-Mg on major clinical outcomes.

TRIAL REGISTRATION

The study was retrospectively registered on the ISRCTN registry (ISRCTN 74139255) on 18 June 2020.

摘要

简介

在接受血液透析的终末期肾病（ESKD）患者中，增加透析液镁（D-Mg）似乎是获得心血管益处的一种很有前途的策略。然而，迄今为止，血液透析指南并未建议常规将 D-Mg 增加至 0.50mmol/L。

方法

一项随机的 4 周交叉研究旨在研究将透析液镁从 0.50mmol/L 增加至 0.75mmol/L 对血液透析患者动脉僵硬、血流动力学特征和内皮功能的影响。在 6 个月的随访中，研究了更高 D-Mg 对矿物质代谢标志物的长期影响。通过重复测量的线性混合模型分析数据。

结果

对 39 名患者的数据进行了分析。与标准 D-Mg 相比，更高 D-Mg 可使脉搏波速度和脉压分别降低 0.91m/s（95%置信区间 -1.52 至 -0.29；p=0.01）和 -9.61mmHg（-18.89 至 -0.33，p=0.04）。还观察到收缩压显著降低 -12.96mmHg（-24.71 至 -1.22，p=0.03）。未观察到周期或延续效应。在长期随访阶段，更高的 D-Mg 显著增加了离子化和总血清镁（分别从 0.54mmol/L 增加至 0.64mmol/L 和从 0.84mmol/L 增加至 1.07mmol/L；从基线到随访的平均百分比变化分别为 +21%和 +27%；p≤0.001），而甲状旁腺激素（PTH）显著降低（从 36.6pmol/L 降至 34.4pmol/L；%变化 -11%，p=0.03）。