title: Dialysate temperature adjustment as an effective treatment for baroreflex failure syndrome in hemodialysis patient.
abstract: BACKGROUND
  Baroreflex failure syndrome is a rare disorder which causes labile blood pressure, headache, flushing, diaphoresis and emotional lability. It is caused by history of trauma or radiotherapy in the cervical legion, bilateral carotid-body tumor or resection of glossopharyngeal nerve. We experienced a case of hemodialysis patient who had difficulty in controlling blood pressure during dialysis because of his baroreflex failure syndrome and successfully controlled his blood pressure by adjusting dialysate temperature.
  
  
  METHODS
  We report a case of a 68-year-old CKD5 patient who had difficulty in hemodialysis treatment because of severe fluctuations in blood pressure with hypertensive attacks and hypotensive episodes which caused him a severe discomfort. His dialysis treatment was started in 2010 and since that time baroreflex failure syndrome has been suspected because of his clinical manifestations and history of radiotherapy in the cervical region for his lingual cancer in 1994. Baroreflex failure syndrome is diagnosed by symptoms and cold stressor test. We performed a cold stressor test on an experimental baroreflex failure syndrome mouse and induced a significant elevation of blood pressure. From this experimental finding of model mouse, we changed the patients dialysate temperature between 34-38° according to his change in blood pressure though 80-240 mmHg. From this attempt, his blood pressure was successfully controlled between 100-180 mmHg and he was able to continue hemodialysis without any discomfort.
  
  
  CONCLUSIONS
  In our case, environmental stimulation such as temperature change modified the patients fluctuating blood pressure. Change of dialysate temperature could be an option for controlling the unstable blood pressure due to baroreflex failure syndrome.
authors.affiliation: Jikei University Hospital, 3-25-8, Nishishimbashi, Minato-ku, Tokyo 105-0003, Japan. h19mstanabe@gmail.com.
authors.forename: Natsumi
authors.initials: N
authors.lastname: Tanabe
authors.forename: Koki
authors.initials: K
authors.lastname: Takane
authors.forename: Keitaro
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Yudo
authors.initials: Y
authors.lastname: Tanno
authors.forename: Izumi
authors.initials: I
authors.lastname: Yamamoto
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ohkido
authors.forename: Takashi
authors.initials: T
authors.lastname: Yokoo
mesh_terms: D000368:Aged; D017704:Baroreflex / Q000528:radiation effects; D002346:Carotid Sinus / Q000528:radiation effects; D003080:Cold Temperature; D015314:Dialysis Solutions; D004244:Dizziness / Q000209:etiology; D015103:Droxidopa / Q000627:therapeutic use; D004750:Enteral Nutrition / Q000009:adverse effects; D005774:Gastrostomy; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008879:Midodrine / Q000627:therapeutic use; D011187:Posture; D011832:Radiation Injuries / Q000150:complications*; D011878:Radiotherapy / Q000009:adverse effects; D012021:Reflex, Abnormal; D006435:Renal Dialysis / Q000009:adverse effects*; D012964:Sodium / Q000378:metabolism; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013696:Temperature; D014062:Tongue Neoplasms / Q000532:radiotherapy
chemical_list: D015314:Dialysis Solutions; D008879:Midodrine; D012964:Sodium; D015103:Droxidopa