Effect of Lowering the Dialysate Temperature in Chronic Hemodialysis

Abstract

Background and objectives Lowering the dialysate temperature may improve outcomes for patients undergoing chronic hemodialysis. We reviewed the reported benefits and harms of lower temperature dialysis.Design, setting, participants, & measurements We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and Pubmed until April 15, 2015. We reviewed the reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included all randomized, controlled trials that evaluated the effect of reduced temperature dialysis versus standard temperature dialysis in adult patients receiving chronic hemodialysis. We followed the Grading of Recommendations Assessment, Development and Evaluation approach to assess confidence in the estimates of effect (i.e., the quality of evidence). We conducted meta-analyses using random effects models.Results Twenty-six trials were included, consisting of a total of 484 patients. Compared with standard temperature dialysis, reduced temperature dialysis significantly reduced the rate of intradialytic hypotension by 70% (95% confidence interval, 49% to 89%) and significantly increased intradialytic mean arterial pressure by 12 mmHg (95% confidence interval, 8 to 16 mmHg). Symptoms of discomfort occurred 2.95 (95% confidence interval, 0.88 to 9.82) times more often with reduced temperature compared with standard temperature dialysis. The effect on dialysis adequacy was not significantly different, with a Kt/V mean difference of 20.05 (95% confidence interval, 20.09 to 0.01). Small sample sizes, loss to follow-up, and a lack of appropriate blinding in some trials reduced confidence in the estimates of effect. None of the trials reported long-term outcomes.Conclusions In patients receiving chronic hemodialysis, reduced temperature dialysis may reduce the rate of intradialytic hypotension and increase intradialytic mean arterial pressure. High-quality, large, multicenter, randomized trials are needed to determine whether reduced temperature dialysis affects patient mortality and major adverse cardiovascular events.

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

“…In fact, the mean dialysate temperature was similar in patients with recovery time below and above the median value. It is well known that low dialysate temperature increases arterial pressure in hypotensive hemodialysis patients and reduces the prevalence of intradialytic hypotensive events [37]. Recently, one study has investigated the effect of low temperature on fatigue showing that the switch from 37 to 35 ° C dialysate temperature determined lower severity and duration of fatigue [38].…”

Prevalence and associated variables of post‐dialysis fatigue: Results of a prospective multicentre study

“…In fact, the mean dialysate temperature was similar in patients with and without PDF and, accordingly, the prevalence of PDF was unvaried when patients were stratified according to the dialysate temperature. It is well‐known that low dialysate temperature increases arterial pressure in hypotensive haemodialysis patients and reduces the prevalence of intradialytic hypotensive events . Unfortunately, only one study has investigated the effect of low temperature on fatigue.…”

Cold dialysis and its impact on renal patients’ health: An evidence-based mini review

“…Many studies including two systematic reviews concluded that cold dialysis do not change blood volume, urea rebound or effective Kt/V index leaving dialysis efficiency unchanged[6,14] while one study showed significant improvements in urea removal and Kt/V[24]. …”