From the Guidelines
Peritoneal dialysis can be used to treat hypermagnesemia, but its effectiveness is limited compared to hemodialysis, and it is not the preferred method for severe or life-threatening cases. The treatment of hypermagnesemia using peritoneal dialysis involves the use of a magnesium-free dialysate solution to maximize the concentration gradient and enhance removal of excess magnesium from the blood. The process typically requires multiple exchanges over several hours or days, depending on the severity of toxicity. Key factors that influence the effectiveness of peritoneal dialysis for magnesium removal include membrane permeability, dialysate volume, dwell time, and the number of exchanges performed 1. In addition to dialysis, treatment of hypermagnesemia should include addressing the underlying cause, discontinuing magnesium-containing medications or supplements, and providing supportive care for symptoms like hypotension, respiratory depression, or cardiac abnormalities. It is also important to note that prevention of electrolyte disorders during kidney replacement therapy (KRT) can be achieved by using dialysis solutions containing potassium, phosphate, and magnesium, which can help prevent hypophosphatemia, hypokalemia, and hypomagnesemia 1. However, the use of peritoneal dialysis for hypermagnesemia is not as commonly recommended as hemodialysis, due to its lower efficiency in removing solute and fluid, as noted in the management of tumor lysis syndrome 1. Therefore, while peritoneal dialysis can be used to treat hypermagnesemia, its limitations and the availability of more effective alternatives, such as hemodialysis, should be considered in the management of this condition.
From the Research
Peritoneal Dialysis and Hypermagnesemia
- Peritoneal dialysis (PD) can be used to treat hypermagnesemia, as it allows for the removal of excess magnesium from the body 2.
- The effectiveness of PD in treating hypermagnesemia depends on various factors, including the type of dialysis fluid used, the frequency and duration of dialysis sessions, and the individual patient's condition 3, 2.
- Studies have shown that PD can be effective in reducing serum magnesium levels in patients with hypermagnesemia, particularly when using dialysis fluids with lower magnesium concentrations 2.
Magnesium Elimination in Peritoneal Dialysis
- Magnesium elimination in PD is similar to small solute transport characteristics, with the absolute differences among patients with slower and faster transport types being small 3.
- The elimination of magnesium per liter of dialysis fluid and the absolute removal during a 4-hour dwell are significantly different among patients with different peritoneal transport statuses 3.
- Magnesium supplementation in PD patients should be guided by serum magnesium concentrations rather than the amount of peritoneal elimination 3.
Dialysis Fluid Composition and Magnesium Mass Transfer
- The composition of the dialysis fluid, including the concentration of calcium and magnesium, can affect magnesium mass transfer in PD patients 2, 4.
- A lower dialysate calcium concentration can result in negative mass transfer of calcium, while a lower dialysate magnesium concentration can result in negative mass transfer of magnesium 2.
- The use of glucose polymer-based dialysis fluids, such as icodextrin, can affect the flux of calcium and magnesium during long dwells, with ultrafiltration rate being a significant factor determining the flux of both ions 4.