| Summary: | Albeit low magnesium levels are a known mortality factor in dialysis patients, low (0.5 mmol/l Mg) dialysate magnesium is routinely used. The apprehension that hypermagnesemia will be induced by higher dialysate magnesium prevents its use. How high patients′ magnesium levels actually are is mostly unknown, since magnesium levels are not even routinely measured. Thus, we determined the predialytic magnesium levels in 205 outpatients, dialysed with a magnesium concentration of 0.5 mmol/l and found them lower compared to age matched non dialysis patients. In another group of 54 patients we demonstrated that dialysis itself causes a significant loss of magnesium. We tested different magnesium substitutions and found higher dialysate magnesium levels of 0.75 mmol/l convenient to handle. To study the safety of such dialysate magnesium levels, we utilized a dialysate magnesium of 0.75 mmol/l in 34 patients over 30 months and heeded for complications due to hypermagnesemia. Before substitution, magnesium levels were in the low range of 0.53 mmol/l. The elevated magnesium dialysate increased serum levels to 0.63 mmol/l and was not associated to any apparent side effects or significant changes in calcium, phosphate or iPTH levels. In summary, a higher dialysate magnesium concentration is safe and averts the loss of magnesium during dialysis.
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