Short-term Individualized Dialysate Cooling in Chronic Hemodialysis: Therapeutic benefits for Patients and A favorite choice for Nephrologists

Abstract

Background: Intra-dialytic hypotension (IDH) and pruritus are frequent and distressing complications during hemodialysis; moreover, they are associated with adverse outcomes. The aim of the work: The current work aimed to investigate the effect of applying individualized cool dialysate (ICD) on IDH, dialysis adequacy, pruritus and its acceptance by both patient and nephrologists. Patients and Methods: This is a non-randomized single center study that was conducted at Al-Azher nephrology and dialysis unit. The study was carried out over a period of fvie weeks. Core body temperature (CBT) and dialysis adequacy (by Kt/v) were measured. Patients who fulfilled the inclusion and exclusion criteria underwent hemodialysis for six consecutive sessions at dialysate temperature of 37°C, followed by another six consecutive sessions at ICD temperature (0.5 oC below CBT). Blood pressure (BP) measurements, episodes of hypotension, pruritus score, patients and nephrologist questionnaire were collected during both standard and cool phases. Results: The study included 50 patients, the mean age 51.10±11.57 years, and males constituted 64% . The implementation of ICD has been associated with a significant reduction in IDH episodes (p <0.001). The lowest intra-dialytic and post-dialytic BP measurements were statistically higher during cool phase. There was a significant reduction in pruritus VAS score during cool phase (p <0.001), whereas Kt/v and ultrafiltration rate did not statistically differ between both phases. ICD was well tolerated by patients; although 60% of them experienced cold sensation that warranted no intervention. Nephrologists (n=20) trusted in cool dialysate as an effective intervention for IDH management. However, a proportion of them (60%) had a concern about patient tolerability. Conclusion: ICD is a well-tolerated intervention that is universally applied without additional cost. It improves hemodynamic instability and pruritus during hemodialysis treatment without negative impact on dialysis adequacy. It is accepted by nephrologists as an effective tool in stabilizing hemodynamic instability during dialysis treatment.

Keywords

• cool
• hemodialysis
• hypotension
• pruritus
• adequacy