Control of core temperature and blood pressure stability during hemodialysis.
OBJECTIVE
Cool dialysate may ameliorate intradialytic hypotension (IDH). It is not known whether it is sufficient to prevent an increase in core temperature (CT) during hemodialysis (HD) or whether a mild decline in CT would yield superior results. The aim of this study was to compare both approaches with regard to IDH.


METHODS
Fourteen HD patients with a history of IDH were studied. During three mid-week HD treatments, CT was set to decrease by 0.5 degrees C ("cooling") or to remain unchanged at the baseline level ("isothermic"). "Thermoneutral" HD (no energy is added to or removed from the patient) was used as a control. Central blood volume (CBV), BP, skin temperature, heart rate variability [low and high frequency] were recorded.


RESULTS
CT increased during thermoneutral and remained respectively stable and decreased during isothermic and cooling. Skin temperature decreased significantly during isothermic and cooling, but not during thermoneutral. Nadir systolic BP (SBP) levels were lower during isothermic and thermoneutral compared with cooling. CBV tended to be higher during cooling compared with isothermic and thermoneutral. Three patients complained of shivering during cooling. Change in LF/HF was not different between cooling, isothermic, and thermoneutral.


CONCLUSIONS
IDH may be slightly improved by cooling compared with the isothermic approach, possibly because of improved maintenance of CBV. The hemodynamic effects of mild blood cooling should be balanced against a potentially higher risk of cold discomfort.
Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands. fvs@groupwise.azm.nl
Frank M
FM
van der Sande
Grzegorz
G
Wystrychowski
Jeroen P
JP
Kooman
Laura
L
Rosales
Jochen
J
Raimann
Peter
P
Kotanko
Mary
M
Carter
Christopher T
CT
Chan
Karel M L
KM
Leunissen
Nathan W
NW
Levin
D000368:Aged; D001794:Blood Pressure; D001810:Blood Volume; D001833:Body Temperature Regulation; D003080:Cold Temperature / Q000009:adverse effects; D018592:Cross-Over Studies; D004734:Energy Metabolism; D005260:Female; D006339:Heart Rate; D015312:Hemodialysis Solutions / Q000009:adverse effects; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D012768:Shivering; D012881:Skin Temperature
D015312:Hemodialysis Solutions