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

Corrispondenza a:
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

Ci spiace, ma questo articolo è disponibile soltanto in inglese.

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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Emodialisi Extracorporea Domiciliare: esperienza e risultati preliminari del primo centro 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

L’emodialisi domiciliare (HHD) è un’alternativa ancora poco utilizzata, ma in grado di offrire migliori outcomes clinici ed una più soddisfacente qualità della vita. Il Piano Sanitario della Regione Campania 2011-2013 afferma che “per la programmazione regionale riveste particolare importanza il sistema di cure domiciliari”.

Da Agosto 2014 a Marzo 2015 due pazienti che praticavano Emodialisi Standard (HD), presso il Centro Dialisi della Università “Federico II” di Napoli, sono stati avviati alla Short Daily Home Hemodialysis (SDHHD, 4-6 trattamenti dialitici/settimana della durata ognuno di circa 2,5 ore) utilizzando il cycler portatile NxStage-System One.

I dati raccolti hanno evidenziato che i benefici clinici descritti in letteratura si confermavano nei pazienti arruolati nel nostro programma di HHD. L’effettuazione di sedute emodialitiche più brevi e frequenti permettevano una significativa riduzione dell’incremento ponderale interdialitico ed una maggiore stabilità emodinamica intradialitica. Inoltre, si è ottenuta una significativa riduzione dei valori pressori con possibilità di ridurre la terapia anti-ipertensiva. Il controllo della fosforemia risultava migliore e l’emoglobinemia era a target con una minore dose di eritropoetina settimanale.

I pazienti riferivano un maggiore senso di benessere ed una riduzione dell’astenia post-dialitica. Nessuna problematica è insorta utilizzando l’accesso vascolare (CVC e FAV) da parte del paziente e/o del caregiver. L’analisi dei parametri di efficienza dialitica ha documentato come l’adeguatezza dialitica della SDHHD sia sovrapponibile a quella ottenuta con la HD tradizionale. L’esperienza fatta con la HHD è incoraggiante poiché si è ottenuta una dose dialitica “adeguata” senza nessuna complicanza ed i pazienti hanno riferito un maggiore benessere psicofisico ed una migliore qualità della vita.

Parole chiave: Emodialisi Extracorporea Domiciliare, Dialisi Breve Giornaliera Domiciliare, Adeguatezza Dialitica, Qualità della Vita.

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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