Background/aim
Emerging evidence on lowering dialysate temperature suggests a cardiorenal
protective effect of dialysate cooling (CD) against dialysis-induced ischemia in
hemodialysis (HD) patients prone to intradialytic hypotension (IDH). Whether this
benefit of CD could be extended to incident HD populations without baseline IDH to
preserve residual kidney function (RKF) is unknown.
Patients and methods
One hundred incident HD patients were randomly assigned to receive either
incremental CD less than or equal to 36°C (intervention, N=50 patients) or
standard-temperature (ST) dialysate (control, N=50 patients) for 12 months. The
primary endpoint was to test the safety and efficacy of CD to preserve RKF.
Results
By the end of 12 months, CD patients showed less decline in estimated glomerular
filtration rate compared with standard-temperature patients (6.2 vs. 4.6 ml/min/
1.73 m2
, P=0.025); in addition, Cox regression analysis showed that CD was an
independent variable for the preservation of RKF (P=0.044, hazard ratio: 0.478,
confidence interval: 0.23–0.89). CD was well tolerated, with less fatigue and IDH;
however, coldness, shivering, and discomfort were significantly higher in the CD
group.
Conclusion
In incident HD patients without baseline IDH, cooled dialysis might help preserve
RKF with a reasonable safety profile. Further studies are warranted to explore these
findings. |
