The Effect of Dialysate Temperature on Dialysis Adequacy and Hemodynamic Stability: An Experimental Study with Crossover Design

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Gerry George Mathew

DOI: 10.69097/41-04-2024-12

Gerry George Mathew1, Suganya Muthukarupiah2, Muthamizh Muniappan3, Judhajit Maiti4, Varadharajan Jayaprakash5

1 Associate Professor, Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India-603203
2 Senior resident, Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India-603203
3 Lecturer, Renal dialysis Technology. Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India-603203
4 Senior resident, Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India-603203
5 Professor and Head, Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India-603203

Corresponding author:
Gerry George Mathew
E-mail: gerrygeorge007@gmail.com
Mobile no: +91-8291077361

 

Abstract

Cool dialysate has variable impact on hemodynamic stability and dialysis adequacy.  Hemodynamic stability and dialysis adequacy are crucial indicators for better life expectancy and cardiovascular mortality. This research aims to evaluate the impact of cool dialysate temperature (35.5°C) compared to standard dialysate temperature (37°C) on blood pressures, pulse rate, and dialysis adequacy (Urea reduction ratio and online Kt/V) in a cross over design.
Material and Methods. Consenting ESRD patients on maintenance haemodialysis (HD) with minimum 3 months dialysis vintage and functioning permanent vascular access are included for the study. Each participant had two sessions of HD at 37°C followed by two sessions at 35.5° C on a Fresenius 4008S HD machine. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and Pulse rate are measured pre-HD, every hourly and post dialysis. Pre-HD Blood urea nitrogen (BUN) and post-HD BUN are measured, and Urea reduction rate was calculated for each HD session. Kt/V was calculated by ionic conductance by HD machine for each session.
Results. 25 patients (5 females and 20 males) were enrolled. The mean age was 54 ± 9.58 years. Dialysis vintage was 21.48 ± 6.9 months for study participants 10 patients (40%) were diabetic nephropathy, 9 patients (36%) were presumed chronic glomerulonephritis, 2 patients (8%) were lupus nephritis and 4 patients (16%) were chronic interstitial nephritis. There was statistically no difference between pre-HD BUN (p = 0.330), post-HD BUN (p = 0.776), URR (p = 0.718) and Kt/V (p = 0.534) among the dialysis sessions done at 37°C and 35.5°C.
SBP variability in the low temperature (35.5°C) group at 4th hour and post dialysis assumed statistical significance with p = 0.05 and p = 0.025 respectively. DBP variability in the low temperature (35.5°C) group at 3rd hour, 4th hour and post-dialysis demonstrated statistical significance with p = 0.027, p = 0.36 and p = 0.016 respectively. Pulse rate variability was more in the low temperature (35.5°C) group at 3rd hour and 4th hour which showed statistical significance with p = 0.037 and p = 0.05 respectively.
Conclusion. Cool dialysate is non inferior to standard dialysate temperature in terms of dialysis adequacy and is associated with less variability in diastolic blood pressure, systolic blood pressure and more pulse rate variability thereby contributing to better hemodynamic stability.

Keywords: Cool dialysate, Dialysis adequacy, Hemodynamic stability, Pulse rate variability

Introduction

Hemodynamic stability and dialysis adequacy in hemodialysis translates to better quality of life and greater life expectancy [1]. One of the most adopted practices to enhance hemodynamic stability and prevent intradialytic hypotension is the use of cool dialysate [2]. Cardiovascular stability is improved due to increased peripheral resistance and tonicity of blood vessels along with secretion of catecholamine in the clinical context of cool dialysate [3]. Cool dialysate has not become popular due to patient perception of chills and shiver during haemodialysis and its theoretical risk of inferior dialysis adequacy due to entrapment of blood in peripheral blood vessels [4].

Hemodynamic stability is a well-established impact of cool dialysate; however, its influence on the clearance of uremic toxins is still debatable. Intercompartmental resistance is still a realistic concern in cool dialysate which may deter clearance and contribute to dialysis inadequacy [5]. Previous studies [6] have analysed the hemodynamic variability associated with a cool dialysate, but only few studies have conjointly analysed hemodynamics and dialysis adequacy in the same clinical setting. Our study aimed at evaluating the impact of cool dialysis (35.5°C) compared to standard dialysate temperature (37 °C) on blood pressures, pulse rate and dialysis adequacy (Urea reduction ratio (URR) and online Kt/V) in a crossover design study. 

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Home Hemodialysis: Experience and Preliminary Results Of The First Center In Campania

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Stefania Brancaccio, Alfredo Capuano, Andea Memoli, Livia Maria Sorrentino, Laura Pirro, Stefano Federico.

Cattedra di Nefrologia, Dipartimento di Sanità Pubblica, Università di Napoli “Federico II”

Corrispondenza a:
Dott.ssa Stefania Brancaccio,
Via Sergio Pansini 5, 80131 Napoli
Tel-Fax 081/7462147
e-mail: stefybranc@gmail.com

 

Abstract

The Home Hemodialysis (HHD) is an uncommon dialytic option that can offer better clinical outcomes and a more satisfactory quality of life. The Health Plan of the Region Campania 2011-2013 states that” the system of home care for regional planning is particularly important”.

From August 2014 to March 2015 two patients, on standard dialysis (HD) as inpatients at Dialysis Centre of the University “Federico II” of Naples, started Short Daily Home Hemodialysis (SDHD) (4-6 dialysis treatments/week, 2.5 hours per session) using the portable cycler NxStage System One).

The data collected showed that the clinical benefits described in the literature were confirmed in patients enrolled in this HHD program. Shorter and more frequent hemodialysis sessions allowed a significant reduction in interdialytic weight gain and greater intradialytic hemodynamic stability. A significant reduction in blood pressure and anti-hypertensive drugs were obtained. The control of phosphorus appeared better and hemoglobin was to target with a lower dose of weekly erythropoetin. The patients reported a greater well-being and a reduction in post-dialytic asthenia. No problem has been reported in using the vascular access (CVC and FAV) by the patient/caregiver. The dialysis adequacy and efficiency were comparable between SDHD and HD. The experience with the HHD is encouraging as the patients achieved an adequate dialysis dose without any complications reporting an improving sense of well-being and a better quality of life.

Key Words: Home Hemodialysis, Short Daily Home Hemodialysis, Dialysis Adequacy, Quality of Life.

Sorry, this entry is only available in Italian.

L’Emodialisi Extracorporea Domiciliare (HHD) è un’alternativa non ancora ben conosciuta nel panorama dei trattamenti sostitutivi dell’insufficienza renale cronica. Questo tipo di modalità dialitica, già utilizzata in altri Paesi e in alcune Regioni Italiane, può offrire significativi vantaggi in termini di outcomes clinici, socio-economici e soprattutto di qualità della vita del paziente. 

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