Dialysate, the fluid used in dialysis, is a critical component of the treatment. Yet little evidence is available to guide its optimal formulation. In particular, the concentration of magnesium in dialysis has received little scientific attention until recently. New research suggests that a higher dialysate magnesium concentration may benefit patients.

Magnesium is an essential element that supports heart, muscle, and bone health. During dialysis, dialysis machines remove some magnesium from the blood. However, dialysate has magnesium added to replace the magnesium removed during the dialysis process. The concentrations of magnesium in dialysate can vary depending upon the manufacturer and the prescribing physician’s orders. Prior smaller trials determined that lower concentrations of magnesium were associated with a higher risk of cardiovascular disease, muscle cramps, and fractures.

We embedded the Dial-Mag Trial into routine hemodialysis care. The trial team supplies the allocated therapy to the unit with no alterations to existing treatment or additional patient visits. The majority of the trial data is routinely collected as a part of standard health care practice. As a result, the implementation of Dial-Mag creates very few, if any, disruptions to the workflow of ongoing healthcare to dialysis patients.

We randomised the hemodialysis centres into two groups: the first will administer a dialysate magnesium concentration of less than or equal to 0.5 mmol/L, and the second will administer a dialysate magnesium concentration of 0.75 mmol/L. During the trial participating centres will provide the same dialysate magnesium concentration to all patients receiving care in the centre. The trial team collect patients’ health outcomes throughout the duration of the trial. We hope to report the results by Fall 2027 and anticipate we will include more than 8 million hemodialysis sessions during the trial period