Table 2.

Possible adverse effects secondary to the prescription of the wrong haemodialysate; the table shows, for each component of the haemodialysate, the major possible short-term and long-term adverse reactions secondary to an excessively low (left column) or to an excessively high dialysate concentration (right column).

Adverse reactions due to an excessively LOW concentration		Adverse reactions due to an excessively HIGH concentration
– Intradialytic cardiovascular instability – Disequilibrium symptoms (fatigue, muscle cramps, headache, etc.)	Na+	– Refractory hypertension – Intradialytic hypertension – Increased thirst sense – Pulmonary edema
– Arrhytmogenic effect amplified by a rapid correction of metabolic acidosis, low dialysate calcium concentration, high ultrafiltration rate, abrupt kalemia decrease	K+	– Risk of insufficient potassium removal with secondary hyperkalemia in the interdialytic period – Increased mortality
– Hypotension and cardiac arrhythmias during hemodialysis and long-term risk of secondary hyperparathyroidism – Increased risk of sudden cardiac arrest – Increased circulating parathyroid hormone levels (PTH) in the presence of adynamic bone disease and low serum PTH levels – Risk of excessive bone mineral loss in patients with long daily or nocturnal hemodialysis sessions	Ca++	– Long-term risk of vascular and valvular calcifications – Significantly higher risk of cardiovascular and sudden death in patients who are taking a calcium-based phosphate binder – Risk of over suppression of parathyroid hormone and adynamic bone disease, with high plasma [Ca] and soft-tissue calcifications
– Leg cramps – Significant drop in mean arterial pressure in the association of dialysate calcium concentration of 1.25 mmol/L and magnesium concentration of 0.25 mmol/L	Mg++	– Signs and symptoms of hypermagnesemia (hyporeflexia, weakness up to paralysis that can involve the diaphragm, bradycardia, hypotension, cardiac arrest, inhibition of parathyroid hormone secretion with secondary hypocalcemia)
– Acidosis with secondary abnormal protein metabolism and malnutrition – Osteodystrophy	HCO3−	– Increased calcium binding to proteins, reduction of ionized calcium, and impaired cardiac muscle contraction and arterial pressure preservation – Hypoxemia, with further impaired cardiac function – Increased potassium removal – Accelerated tissue calcium phosphate precipitation
– Risk of hypoglycemia – Greater loss of aminoacids in the dialysate – Higher potassium removal secondary to alkalosis	Glucose	– Impaired triglyceride metabolism – Risk of pro-inflammatory stimulus secondary to hyperglycemia