Influence of dialysate temperature on creatinine peritoneal clearance in peritoneal dialysis patients: a randomized trial

Abstract

Background Patients on continuous ambulatory peritoneal dialysis (PD) are encouraged to warm dialysate to 37 °C before peritoneal infusion; main international PD guidelines do not provide specific recommendation, and patients generally warm dialysate batches partially or do not warm them at all. Warming of dialysate is a time-consuming procedure, not free from potential risks (i.e. degradation of glucose), and should be justified by a clear clinical benefit. Methods We designed a single blind randomized controlled trial where 18 stable PD patients were randomized to receive a peritoneal equilibration test either with dialysate at a controlled temperature of 37 °C (intervention group) or with dialysate warmed with conventional methods (control group). Primary end-point was a higher peritoneal creatinine clearance in patients in the intervention group. Results Patients in the intervention group did not show a significantly higher peritoneal creatinine clearance when compared to the control group (6.38 ± 0.52 ml/min vs 5.65 ± 0.37 ml/min, p = 0.2682). Similar results were obtained for urea peritoneal clearance, mass transfer area coefficient of creatinine and urea. There were no significant differences in total abdominal discomfort questionnaire score, blood pressure and body temperature between the two groups. Conclusions Using peritoneal dialysate at different temperatures without causing significant side effects to patients appears feasible. We report a lack of benefit of warming peritoneal dialysate to 37 °C on peritoneal clearances; future PD guidelines should not reinforce this recommendation. Trial registration NCT04302649, ClinicalTrials.gov; date of registration 10/3/2020 (retrospectively registered).

Culture-directed antibiotics in peritoneal dialysis solutions: a systematic review focused on stability and compatibility

“…Contrary to the environment in the pharmaceutical laboratory with constant temperature monitoring systems, the effects of temperature fluctuations and the duration outside refrigerated conditions during transportation on drug stability remain unknown. Data on the best practice for warming the PD bag prior to use remains unclear [ 110 ]. Whilst the manufacturers have recommended heating PD solutions with dry heat (i.e., heating pad), it must be noted that overheating could result in drug degradation and the formation of toxic GDP [ 110 , 111 ].…”

“…Data on the best practice for warming the PD bag prior to use remains unclear [ 110 ]. Whilst the manufacturers have recommended heating PD solutions with dry heat (i.e., heating pad), it must be noted that overheating could result in drug degradation and the formation of toxic GDP [ 110 , 111 ]. Therefore, the accidental overheating of the PD bag beyond 37 °C in the patient’s home environment, which could potentially affect the drug stability resulting in loss of pharmacological activity, cannot be ruled out.…”