Why thermosensing? A primer on thermoregulation

Passlick–Deetjen, Jutta; Bedenbender-Stoll, Eva

doi:10.1093/ndt/gfh901

Cited by 18 publications

(12 citation statements)

References 43 publications

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“…These factors may underlie the reduced sensitivity and specificity of ischaemia stress testing in HD patients [5]. The HD procedure involves a rise in core temperature, extracorporeal circuit, fluid removal and exposure to a dialysis membrane which combine to form a haemodynamic stress provoking demand ischaemia [6]. Our natural history study of 70 prevalent HD patients showed that compared to pre-HD echocardiography, new RWMAs developed at peak-stress in 45 participants and this associated with 30% mortality and 13% reduction in mean left ventricular ejection fraction by 1 year [7,8].…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of a multi-centre randomised controlled trial of individualised cooled dialysate to prevent left ventricular systolic dysfunction in haemodialysis patients

et al. 2012

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BackgroundThe main hypothesis of this study is that patients having regular conventional haemodialysis (HD) will have a smaller decline in cardiac systolic function by using cooler dialysate. Cooler dialysate may also be beneficial for brain function.Methods/DesignThe trial is a multicentre, prospective, randomised, un-blinded, controlled trial. Patients will be randomised 1:1 to use a dialysate temperature of 37°C for 12 months or an individualised cooled dialysate. The latter will be set at 0.5°C less than the patient’s own temperature, determined from the mean of 6 prior treatment sessions with a tympanic thermometer, up to a maximum of 36°C. Protocol adherence will be regularly checked. Inclusion criteria are incident adult HD patients within 180 days of commencing in-centre treatment 3 times per week with capacity to consent for the trial and without contra-indications for magnetic resonance imaging. Exclusion criteria include not meeting inclusion criteria, inability to tolerate magnetic resonance imaging and New York Heart Association Grade IV heart failure. During the study period, resting cardiac and cerebral magnetic resonance imaging will be performed at baseline and 12 months on an inter-dialytic day. Cardiovascular performance during HD will also be assessed by continuous cardiac output monitors, intra-dialytic echocardiography and biomarkers at baseline and 12 months. The primary outcome measure is a 5% between-group difference in left ventricular ejection fraction measured by cardiac magnetic resonance imaging at 12 months compared to baseline. Analysis will be by intention-to-treat. Secondary outcome measures will include changes in cerebral microstructure and changes in cardiovascular performance during HD. A total of 73 patients have been recruited into the trial from four UK centres. The trial is funded by a Research for Patient Benefit Grant from the National Institute of Healthcare Research. AO is funded by a British Heart Foundation Clinical Research Training Fellowship Grant. The funders had no role in the design of the study.DiscussionThis investigator-initiated study has been designed to provide evidence to help nephrologists determine the optimal dialysate temperature for preserving cardiac and cerebral function in HD patients.Trial registrationISRCTN00206012 and UKCRN ID 7422

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Section: Introductionmentioning

confidence: 99%

Rationale and design of a multi-centre randomised controlled trial of individualised cooled dialysate to prevent left ventricular systolic dysfunction in haemodialysis patients

et al. 2012

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“…Since it is simple and painless to perform and thus well accepted by patients, and its results are also well reproducible, thermography has become established an integral component of complex diagnostic schemata, especially in the diagnosis of pain and monitoring of the course of peripheral disorders of the cardiovascular circulation [2,3]. The diagnosis of thermoregulation is used on the one hand to determine the pattern of skin temperature in selected areas of the body during minimal stress to the regulation system [4,5], and on the other to record thermoregulation in these areas following the application of a defined cold stimulus [6,7], laser irradiation [8] or even acupuncture [9].…”

Section: Introductionmentioning

confidence: 99%

Thermography and thermoregulation of the face

2007

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“…The latter two maneuvers prevent or antagonize the HD-induced increase in body core temperature through enhanced thermal energy loss [6]. The rise in the core temperature, which is observed during standard HD, appears crucial for the impaired vascular response during hypovolemia [7]. Noteworthy in this respect are the high plasma nitric oxide (NO) levels in HD patients, particularly in those prone to hypotension [8].…”

Section: Introductionmentioning

confidence: 99%

Reduction in Platelet Activation by Citrate Anticoagulation Does Not Prevent Intradialytic Hemodynamic Instability

Gritters

Borgdorff²,

Grooteman³

et al. 2007

Nephron Clin Pract

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Background: The etiology of intradialytic hemodynamic instability is multifactorial. Of the various factors involved, a rise in core temperature seems to be crucial. In this respect, the bioincompatibility of hemodialysis (HD) treatment might play an important role. The application of cool dialysate reduces the number of periods of intradialytic hypotension (IDH) considerably. In rats, roller pump perfusion caused hypotension by shear stress induced platelet aggregation and subsequent serotonin release. During clinical HD, citrate anticoagulation abolished platelet activation almost completely. Hence, citrate anticoagulation might reduce IDH, whereas the beneficial effect of cool dialysate might be partly explained by reduced platelet activation. Methods: In the present study, blood pressure, IDH episodes, platelet activation, platelet aggregation, and serotonin release were studied crossover in 10 patients during HD with dalteparin anticoagulation at normal and low dialysate temperatures and during HD with citrate. Results: Citrate strongly reduced platelet activation, but did not improve IDH. The blood pressure was best preserved during cool-temperature HD, despite manifest platelet activation. Platelet activation was not accompanied by a rise in the plasma serotonin concentration. Conclusions: Three major conclusions can be drawn: (1) it is unlikely that platelet activation and subsequent serotonin release underlie IDH in the clinical situation; (2) the protective effects of cool dialysate on IDH appear to be independent of HD-induced platelet activation, and (3) extrapolating results from rat experiments to the human situation requires uppermost prudence.

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Why thermosensing? A primer on thermoregulation

Cited by 18 publications

References 43 publications

Rationale and design of a multi-centre randomised controlled trial of individualised cooled dialysate to prevent left ventricular systolic dysfunction in haemodialysis patients

Rationale and design of a multi-centre randomised controlled trial of individualised cooled dialysate to prevent left ventricular systolic dysfunction in haemodialysis patients

Thermography and thermoregulation of the face

Reduction in Platelet Activation by Citrate Anticoagulation Does Not Prevent Intradialytic Hemodynamic Instability

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