title: Individualised dialysate temperature improves intradialytic haemodynamics and abrogates haemodialysis-induced myocardial stunning, without compromising tolerability.
abstract: OBJECTIVE
  Haemodialysis-induced myocardial stunning is associated with intradialytic hypotension, increased likelihood of cardiovascular events and death. Dialysis at 35°C reduces stunning, but adverse thermal symptoms limit technique adoption. This study investigated whether individualised body temperature dialysis improves haemodynamic stability and abrogates stunning.
  
  
  METHODS
  Randomised crossover study of 11 patients compared LV regional wall motion abnormalities (RWMAs) at 37°C (HD(37)) and body temperature ('individualised', HD(ind)). Regional systolic function was quantitatively assessed by echocardiography. Haemodynamics were assessed using continuous pulse wave analysis. Thermal symptoms were scored by questionnaire.
  
  
  RESULTS
  Mean predialysis body temperature was 36.0 ± 0.1°C. Mean number of peak stress RWMAs per patient was lower with HD(ind) (3.9 ± 1.4 vs. 5.3 ± 1.5, p = 0.03). Intradialytic systolic BP was higher during HD(ind) versus HD(37) (p < 0.001). Individualised body temperature dialysis demonstrated symptomatic tolerability comparable to HD(37).
  
  
  CONCLUSIONS
  Individualised-temperature haemodialysis abrogates stunning, providing effective haemodynamic stabilisation at no additional therapy cost.
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Nottingham, UK.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Jefferies
authors.forename: James O
authors.initials: JO
authors.lastname: Burton
authors.forename: Christopher W
authors.initials: CW
authors.lastname: McIntyre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001831:Body Temperature; D018592:Cross-Over Studies; D015314:Dialysis Solutions; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D057285:Precision Medicine / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D013599:Systole / Q000502:physiology*; D013696:Temperature
chemical_list: D015314:Dialysis Solutions