A prospective, randomized clinical trial comparing the effect of cool dialysate temperature on the urea reduction ratio among hemodialysis patients.
Article Sidebar
Main Article Content
Abstract
Background: Hemodialysis with a cool temperature dialysate solution (35-36 degree Celsius) is the strategy to prevent intradialytic hypotension. However, some studies have shown that it may decrease urea reduction ratio (URR), which is one of the indicators of the adequacy of hemodialysis.
Objective: To assess the effect of cool dialysate temperature on the blood pressure and urea reduction ratio in hemodialysis patients.
Methods: The single blind randomized controlled trial was conducted. Participants were 56 hemodialysis patients who older than 18 years old at Chiangrai Prachanukroh Hospital, Thailand. The patients were randomized into 2 groups; cool dialysate temperature and normal dialysate temperature group. The treatment outcomes were measured by mean arterial pressure (MAP) and urea reduction ratio. The baseline characteristics were compared using exact probability tests for categorical variables; Student’s t-test or Wilcoxon rank-sum test was used to compare the mean difference of continuous variables. Multivariable regression analyses were used to evaluate the effects of age, sex, body mass index hemoglobin and serum albumin level between intervention group and control group.
Results: There are no significantly different in pre and post-hemodialysis mean arterial pressure differentiation (5.44±19.55 mmHg vs. 9.13±13.06 mmHg; p=0.430) and urea reduction ratio (53.43±12.69 % vs. 53.17±18.07 %; p=0.950) between cool temperature dialysate and normal temperature dialysate group. All Patients had neither severe adverse reactions, no patients had hypotension during hemodialysis, and nor dropped out from the study.
Conclusions and recommendations: Hemodialysis with a cool dialysate temperature had no effect on blood pressure and didn’t decrease urea reduction ratio. Thus, Normal dialysate temperature was recommended for general hemodialysis.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Siriopol D, Covic A, Basile C, et al. An update review of intradialytic hypotension: concept risk factors, clinical implications and management. Clin Kidney J 2020; 13(6): 981–993.
Sars B, Van der Sande FM, Kooman JP. Intradialytic hypotension: Mechanisms and outcome. Blood Purif 2020; 49:158–167.
Van der Sande FM, Kooman JP, Van Kuijk WHM, Leunissen KML. Management of hypotension in dialysis patients: Role of dialysate temperature control. Saudi J Kidney Dis Transplant 2001;12(3):382-386.
Kooman J, Basci A, Pizzarelli F et al. EBPG guideline on haemodynamic instability. Nephrol Dial Transplant 2007; 22: ii22–ii44
Hussein TA, Malik AS. Effect of dialysate temperature on hemodynamic stability among hemodialysis patients. Iraqi J Med Sci 2014; 12(2): 173-179.
Azar AT. Effect of dialysate temperature on hemodynamic stability among hemodialysis patients. Saudi J Kidney Dis Transplant. 2009; 20(4): 596-03.
Sivasankari M, Jayaprakash V, Indhumathi E, Jagadeswaran D, Srivatsa A, Jayakumar M. The effect of dialysate temperature on urea reduction ratio among patients undergoing maintenance haemodialysis: A Case Control Study. J Clin Diagn Res. 2019; 13(2): 25-28.
Ayoub A, Finlayson M. Effect of cool temperature dialysate on the quality and patients’ perception of haemodialysis. Nephrol Dial Transplant 2004; 19: 190–194.
Bullen A, Rifkin D, Trzebinska D. Individualized cool dialysate as an effective therapy for intradialytic hypotension and hemodialysis patients’ perception. Ther Apher Dial 2019; 23(2): 145–152.
Tsujimoto Y, Tsujimoto H, Nakata Y, Kataoka Y, Kimachi M, Shimizu S, Ikenoue T, Fukuma S, Yamamoto Y, Fukuhara S. Dialysate temperature reduction for intradialytic hypotension for people with chronic kidney disease requiring haemodialysis. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD012598. DOI: 10.1002/14651858.CD012598.pub2.
Sarbaz H, Kiyani F, Keikhaei A, Bouya S. The effect of reduced dialysate temperature on dialysis adequacy of diabetic patients (A Clinical Trial Study). Med Surg Nurs J. 2019; 8(1):e90518.
