title: Simultaneous blood temperature control and blood volume control reduces intradialytic symptoms.
abstract: OBJECTIVE
  Intra-dialytic morbid events (IME; e.g. hypotension, cramps, headaches) are frequent complications during hemodialysis (HD), known to be associated with ultrafiltration-induced hypovolemia and body temperature changes. Feedback control of blood volume adjusts the ultrafiltration rate in order to keep the blood volume above the patient's individual limit; feedback control of blood temperature maintains the mean arterial blood temperature at the individual pre-dialytic level. Each of these methods reduces the frequency of IME.
  
  
  METHODS
  In a randomized clinical trial the simultaneous application of both feedback controls was investigated for the first time. In 15 weeks, each patient went through 3 study phases: an observational screening phase, a standard phase (STD), and a blood temperature- and blood volume-control phase (CTL). Patients with at least 5 sessions with IME out of 15 sessions in the screening phase were eligible for the study and randomized either into sequence STD-CTL or CTL-STD.
  
  
  RESULTS
  26 patients completed the study according to protocol, and 778 HD treatments were analyzed. The general treatment parameters were similar in both study phases: treatment duration (STD: 244 min, CTL: 243 min, NS), pre-dialytic weight (STD: 72.3 kg, CTL: 72.2 kg, NS), and weight loss due to ultrafiltration (STD: 3.26 kg, CTL: 3.15 kg, NS). The proportion of HD treatments with IME was 32.8% during STD and 18.0% during CTL (p=0.024).
  
  
  CONCLUSIONS
  The frequency of HD sessions with IME was significantly reduced by 45% compared to standard HD in this randomized clinical trial by use of individualized HD treatments with simultaneous feedback control of blood volume and blood temperature.
authors.affiliation: Hemodialysis, Vojnomedicinska Akademija, Belgrade - Serbia.
authors.forename: Ljubiša
authors.initials: L
authors.lastname: Veljančic
authors.forename: Jovan
authors.initials: J
authors.lastname: Popović
authors.forename: Milan
authors.initials: M
authors.lastname: Radović
authors.forename: Peter
authors.initials: P
authors.lastname: Ahrenholz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ries
authors.forename: Leon
authors.initials: L
authors.lastname: Frenken
authors.forename: Ralf
authors.initials: R
authors.lastname: Wojke
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001331:Automation; D001810:Blood Volume; D001811:Blood Volume Determination / Q000295:instrumentation; D001833:Body Temperature Regulation; D018592:Cross-Over Studies; D019719:Diagnostic Equipment; D004867:Equipment Design; D005060:Europe; D005246:Feedback; D005260:Female; D006261:Headache / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D020896:Hypovolemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D009120:Muscle Cramp / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012815:Signal Processing, Computer-Assisted; D013821:Thermometers; D013997:Time Factors; D016896:Treatment Outcome