Effect of Varied Temperature Dialysate on Small Sized Toxins Removal in Haemodialysis Patients

Abstract

Introduction:Improving toxin removal can potentially improve the hemodialysis (HD) patient outcome. HD procedure progressed from low efficiency low-flux dialysis to high efficiency high-flux dialysis and currently towards increased acceptance for convection based hemodiafiltration (HDF). However, in all these extracorporeal renal replacement therapies, toxin removal is primarily impaired by inter-compartmental resistance. Dialysate temperature is an easy maneuver which can change the blood temperature, a surrogate of body core temperature. Warm dialysate can increase the body core temperature, resulting in vasodilation and increased mobilization of sequestered toxins to intravascular compartment Patients and methods:Total 80 subjects were recruited for the study. Patients recruited in this study were divided into four groups; patients underwent HD sessions using dialysate which temperatures were (35 ⁰C, 35.5⁰C, 36⁰C, 36.5⁰C).All patients were subjected to history taking and clinical examination. During each study session, pre- and post-dialysis blood samples were collected; These samples were analyzed for small -sized uremic toxins, namely, urea and creatinine. The pre- and post-dialysis blood samples were used for calculating the toxin reduction ratio; URR=100 (initial urea level-post dialysis level)/initial level.Patients’ perceptions about their experiences of the cool temperature dialysate were measured after completion of the dialysis session by means of a questionnaire.Also our study studied the difference between basal body temperature of the patients and dialysate temperature in relation to urea reduction ratio as the patients were divided into 3 groups: (temp < 0.5 °C, temp ≥ 0.5 - 1 °C and temp > 1 °C)

Results:In Our study showed that group 1 (35○C) showed URR (61 % ± 10) ,group 2 (35.5○C) showed URR (82 % ± 14), group 3 (36○C) showed URR (70 % ± 14) and group 4 (36.5○C) showed URR (66 % ± 7).also showed that the highest urea reduction ratio was among patients in whom dialysate temp differs from basal body temp by a range of 0.5 to 1 °C.Despite tolerability of low dialysate temperature; it may be advisable to be in range of 36-36.5° C for patients convenience.

Conclusion: Cool dialysis has no bad effect on adequacy of dialysis in form of urea reduction ratio, it even improved with dialysate temperature 35.5 °C Also showed that the highest urea reduction ratio was among patients in whom dialysate temp differs from basal body temp by a range of 0.5 to 1 ⁰C. So consider low dialysate temperature benefits irrespective of fear of dialysis inadequacy.Despite tolerability of low dialysate temperature; it may be advisable to be in range of 36-36.5° C for patients convenience

Keywords:Cool dialysis, urea, creatinine, Toxins, kidney,hemodialysis.

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