[How can we improve symptomatic hypotension in hemodialysis patients: cold dialysis vs isothermic dialysis].
BACKGROUND
Symptomatic hypotension is the most frequent acute complication affecting patients during chronic hemodialysis treatment sessions. Many reports have demonstrated that the use of cool dialysate has a protective effect on blood pressure during hemodialysis treatments. In the present study, we investigated whether preventing the hyperthermic response had favourable effects on hemodynamic stability during the hemodialysis procedure while affording good tolerance to patients.


METHODS
We investigated the effect of thermal control of dialysate on hemodynamic stability in hypotension-prone patients in our center. Patients were eligible for the study if they had symptomatic hypotensive episodes (> 3/12session/ month) during the screening phase. The study was designed with two phases for the same selected patients and two treatment arms, each phase lasting 4 weeks. In the first phase, we adjusted dialysate temperature on 36 masculineC for 12 sessions (cold dialysis) and in the second phase we used a device allowing the regulation of thermal balance (Blood Temperature Monitor; Fresenius Medical Care, Bad Homberg, Germany), that keep body temperature unchanged (isothermic dialysis).


RESULTS
Nine HD patients were enrolled and completed the study. During the screening phase the mean ultrafiltration was 4 1% of dry weight, and blood pressure decreased from 9916 to 8016 mm Hg (p<0.001). In 5.01.7 sessions of 12 treatments were complicated by hypotension. In the first and second phase we observed a decrease of complicated treatments with symptomatic hypotension (5.01.7 versus 2.71.6 y 2.81.7; p<0.01). Both procedures: Cold dialysis and Isothermic dialysis was well tolerated by patients.


CONCLUSIONS
Results show that active control of body temperature can significantly improve intradialytic tolerance in hypotension-prone patients.
Ramos
R
R
Hospital Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona, Espana. 30965rrs@comb.es
Soto
C
C
Mestres
R
R
Jara
J
J
Zequera
H
H
Merello
J I
JI
Moreso
F
F
D003080:Cold Temperature; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods*