Isothermic hemodialysis and ultrafiltration

Rosales, Laura; Schneditz, Daniel; Morris, Alice T.; Rahmati, Shahriar; Levin, Nathan W.

doi:10.1053/ajkd.2000.8986

Cited by 68 publications

(43 citation statements)

References 15 publications

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“…ST also decreased during T-control treatment with UF and did not change during T-control treatment without UF. In line with the studies of Rosales et al (27,35), a positive relationship between UF volume and energy flow rate was observed during T-control treatment. Still, the equal changes in CT between energy-neutral treatments and the absence of differences in extracorporeal energy flow rate during T-control treatments with and without UF are in contrast with the above-mentioned hypothesis and suggest that factors other than reduced heat loss by peripheral vasoconstriction are involved in heat accumulation during dialysis.…”

Section: Discussionsupporting

confidence: 91%

“…This hypothesis is further supported by the previously shown relation between UF volume and the removal of extracorporeal energy required to maintain a stable CT during body temperature control (isothermic) HD (27). This hypothesis is in some contrast with other observations, using strain-gauge plethysmography, in which only a small increase in forearm vascular resistance was observed during HD combined with UF (8,16,22).…”

supporting

confidence: 63%

“…For power 1 Ϫ ␤ ϭ 0.8 and ␣ ϭ 0.05, seven patients would be needed to detect significant differences with a paired design. A second power analysis using the data of Rosales et al (27) with regard to T-control treatments was performed with the 0-hypothesis-no change in accumulated energy removal during isovolemic T-control HD (HD:T-control ϭ 0)-and the alternative hypothesis-change in accumulated energy removal of Ϫ186 kJ (SD 69 kJ) during T-control HD combined with UF (HDϩUF:T-control ϭ 0). For power 1 Ϫ ␤ ϭ 0.8 and ␣ ϭ 0.05, four patients would be needed to detect significant differences with a paired design.…”

Section: Power Analysismentioning

confidence: 99%

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Effect of Ultrafiltration on Thermal Variables, Skin Temperature, Skin Blood Flow, and Energy Expenditure during Ultrapure Hemodialysis

Sande¹,

Rosales²,

Brener³

et al. 2005

Journal of the American Society of Nephrology

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The cause of the increase in core temperature (CT) during hemodialysis (HD) is still under debate. It has been suggested that peripheral vasoconstriction as a result of hypovolemia, leading to a reduced dissipation of heat from the skin, is the main cause of this increase in CT. If so, then it would be expected that extracorporeal heat flow (Jex) needed to maintain a stable CT (isothermic; T-control ‫؍‬ 0, no change in CT) is largely different between body temperature control HD combined with ultrafiltration (UF) and body temperature control HD without UF (isovolemic). Consequently, significant differences in ⌬CT would be expected between isovolemic HD and HD combined with UF at zero Jex (thermoneutral; E-control ‫؍‬ 0, no supply or removal of thermal energy to and from the extracorporeal circulation). During the latter treatment, the CT is expected to increase. In this study, changes in thermal variables (CT and Jex), skin blood flow, energy expenditure, and cytokines (TNF-␣, IL-1 receptor antagonist, and IL-6) were compared in 13 patients, each undergoing body temperature control (T-control ‫؍‬ 0) HD without and with UF and energy-neutral (E-control ‫؍‬ 0) HD without and with UF. CT increased equally during energy-neutral treatments, with (0.32 ؎ 0.16°C; P ‫؍‬ 0.000) and without (0.27 ؎ 0.29°C; P ‫؍‬ 0.006) UF. In body temperature control treatments, the relationship between Jex and UF tended to be significant (r ‫؍‬ ؊0.51; P ‫؍‬ 0.07); however, there was no significant difference in cooling requirements regardless of whether treatments were done without (؊17.9 ؎ 9.3W) or with UF (؊17.8 ؎ 13.27W). Changes in energy expenditure did not differ among the four treatment modes. There were no significant differences in pre-and postdialysis levels of cytokines within or between treatments. Although fluid removal has an effect on thermal variables, no single mechanism seems to be responsible for the increased heat accumulation during HD. A n inadequate vascular response to hypovolemia is an important contributory factor to intradialytic hypotension. Although various mechanisms have been implicated in the pathogenesis of impaired vascular response during hemodialysis (HD) (1-7), there are strong indications that this phenomenon is often related to changes in body temperature and extracorporeal blood temperature (8 -22).We and others have observed that the core temperature (CT) increased during standard-temperature (37 to 38°C) dialysis (16,18 -24) even with net energy loss from the patient to the extracorporeal system. This phenomenon strongly suggests that the dialysis procedure itself leads to internal heat accumulation. It has been observed that 4 h of standard dialysis leads to a positive internal heat balance of approximately 300 kJ, which represents approximately 30% of the energy expenditure (EEvmax) of the patient (25). The internal heat accumulation might very well be responsible for the impaired vascular response during HD, as the thermoregulatory response (leading to dilation of thermoregulatory vessels) wi...

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Section: Discussionsupporting

confidence: 91%

supporting

confidence: 63%

Section: Power Analysismentioning

confidence: 99%

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Effect of Ultrafiltration on Thermal Variables, Skin Temperature, Skin Blood Flow, and Energy Expenditure during Ultrapure Hemodialysis

Sande¹,

Rosales²,

Brener³

et al. 2005

Journal of the American Society of Nephrology

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“…Apart from reduced heat loss, an increased metabolic rate during dialysis might lead to heat accumulation [11]. However, there are other studies pointing towards a subnormal body temperature in hemodialysis patients [12,13,14]. The explanation for subnormal body temperature in hemodialysis patients remains speculative and it has been hypothesized that the degree of uremia may be related to the hypothermia [12].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, CKD itself as well as hemodialysis may also affect the body temperature. Patients undergoing hemodialysis have an altered homeostasis, which may lead to an altered body temperature, i.e., resulting in a body temperature which is higher or lower than a normal individual [10,11,12,13,14]. Additionally, the long-term survival and quality of life of patients on hemodialysis is dependent on an appropriately placed vascular access; the most reliable long-term method of achieving this being the construction of an arteriovenous fistula (AVF) [15,16].…”

Section: Introductionmentioning

confidence: 99%

Range for Normal Body Temperature in Hemodialysis Patients and Its Comparison with That of Healthy Individuals

et al. 2010

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Background/Aims: Patients with chronic kidney disease undergoing hemodialysis have an altered homeostasis leading to altered body temperatures. We aimed to determine the range for normal body temperature in hemodialysis patients and compared it to healthy individuals. Also, we determined how much axillary temperatures differed from oral temperatures in both groups and whether axillary temperature is affected by the presence of an arteriovenous fistula (AVF) in hemodialysis patients. Methods: Oral and axillary (left & right) temperatures were recorded using an ordinary mercury-in-glass thermometer in 400 subjects (200 hemodialysis patients, 200 healthy individuals) at the Sindh Institute of Urology and Transplantation from mid-May to mid-June 2006. Comparisons were made between the temperatures of both groups. Results: Mean oral temperature in hemodialysis patients was higher than in healthy individuals [98.7°F (37°C) vs. 98.4°F (36.8°C); p < 0.001], as was the mean average axillary temperature [97.7°F (36.5°C) vs. 97.5°F (36.3°C); p = 0.02] and mean left axillary temperature [97.9°F (36.6°C) vs. 97.6°F (36.4°C); p < 0.001]. The fistula arm had higher axillary temperature in 77 (44%) hemodialysis patients. The difference between oral and axillary temperatures varied widely, making it impossible to obtain an accurate correction factor in both groups. Conclusion: Hemodialysis patients have higher normal body temperatures than healthy individuals. Axillary temperatures require cautious interpretation. In hemodialysis patients, the non-fistula arm should be preferred for recording axillary temperatures, as the presence of AVF may cause discrepancies in temperature measurements.

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Dialysate temperature reduction for intradialytic hypotension for people with chronic kidney disease requiring haemodialysis

Tsujimoto

Nakata

et al. 2017

Cochrane Database of Systematic Reviews

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Isothermic hemodialysis and ultrafiltration

Cited by 68 publications

References 15 publications

Effect of Ultrafiltration on Thermal Variables, Skin Temperature, Skin Blood Flow, and Energy Expenditure during Ultrapure Hemodialysis

Effect of Ultrafiltration on Thermal Variables, Skin Temperature, Skin Blood Flow, and Energy Expenditure during Ultrapure Hemodialysis

Range for Normal Body Temperature in Hemodialysis Patients and Its Comparison with That of Healthy Individuals

Dialysate temperature reduction for intradialytic hypotension for people with chronic kidney disease requiring haemodialysis

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