title: Effect of Lowering the Dialysate Temperature in Chronic Hemodialysis: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Lowering the dialysate temperature may improve outcomes for patients undergoing chronic hemodialysis. We reviewed the reported benefits and harms of lower temperature dialysis.
  
  
  METHODS
  We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and Pubmed until April 15, 2015. We reviewed the reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included all randomized, controlled trials that evaluated the effect of reduced temperature dialysis versus standard temperature dialysis in adult patients receiving chronic hemodialysis. We followed the Grading of Recommendations Assessment, Development and Evaluation approach to assess confidence in the estimates of effect (i.e., the quality of evidence). We conducted meta-analyses using random effects models.
  
  
  RESULTS
  Twenty-six trials were included, consisting of a total of 484 patients. Compared with standard temperature dialysis, reduced temperature dialysis significantly reduced the rate of intradialytic hypotension by 70% (95% confidence interval, 49% to 89%) and significantly increased intradialytic mean arterial pressure by 12 mmHg (95% confidence interval, 8 to 16 mmHg). Symptoms of discomfort occurred 2.95 (95% confidence interval, 0.88 to 9.82) times more often with reduced temperature compared with standard temperature dialysis. The effect on dialysis adequacy was not significantly different, with a Kt/V mean difference of -0.05 (95% confidence interval, -0.09 to 0.01). Small sample sizes, loss to follow-up, and a lack of appropriate blinding in some trials reduced confidence in the estimates of effect. None of the trials reported long-term outcomes.
  
  
  CONCLUSIONS
  In patients receiving chronic hemodialysis, reduced temperature dialysis may reduce the rate of intradialytic hypotension and increase intradialytic mean arterial pressure. High-quality, large, multicenter, randomized trials are needed to determine whether reduced temperature dialysis affects patient mortality and major adverse cardiovascular events.
authors.affiliation: Departments of Clinical Epidemiology and Biostatistics and Departments of Medicine and Biomedical and Health Informatics and ramustafa@gmail.com.
authors.forename: Reem A
authors.initials: RA
authors.lastname: Mustafa
authors.affiliation: Departments of Medicine and Biomedical and Health Informatics and.
authors.forename: Fadi
authors.initials: F
authors.lastname: Bdair
authors.affiliation: Departments of Clinical Epidemiology and Biostatistics and Department of Internal Medicine, American University of Beirut, Beirut, Lebanon;
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: Departments of Clinical Epidemiology and Biostatistics and Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada;
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut;
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.affiliation: Departments of Medicine and Biomedical and Health Informatics and.
authors.forename: Hassan
authors.initials: H
authors.lastname: Salameh
authors.affiliation: Departments of Medicine and Biomedical and Health Informatics and.
authors.forename: Sood
authors.initials: S
authors.lastname: Kisra
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada;
authors.forename: Gihad
authors.initials: G
authors.lastname: Nesrallah
authors.affiliation: Department of Medicine, London Health Sciences Centre, London, Ontario, Canada;
authors.forename: Ahmad
authors.initials: A
authors.lastname: Al-Jaishi
authors.affiliation: MD Program, St. James School of Medicine, Chicago, Illinois; and.
authors.forename: Parth
authors.initials: P
authors.lastname: Patel
authors.affiliation: School of Medicine, University of Missouri, Kansas City, Missouri;
authors.forename: Payal
authors.initials: P
authors.lastname: Patel
authors.affiliation: School of Medicine, Jordan University of Science and Technology, Erbid, Jordan.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Mustafa
authors.affiliation: Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada;
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
mesh_terms: D062186:Arterial Pressure; D016009:Chi-Square Distribution; D003080:Cold Temperature / Q000009:adverse effects; D015312:Hemodialysis Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016017:Odds Ratio; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015312:Hemodialysis Solutions
keywords: chronic hemodialysis; cold temperature; dialysis; dialysis solutions; end stage renal disease; follow-up studies; hemodialysis; humans; hypotension; renal dialysis