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Control of Core Temperature and Blood Pressure Stability during Hemodialysis

Frank M. van der Sande^*, Grzegorz Wystrychowski, Jeroen P. Kooman^*, Laura Rosales, Jochen Raimann, Peter Kotanko, Mary Carter, Christopher T. Chan, Karel M.L. Leunissen^*, and Nathan W. Levin

^* Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands; Division of Nephrology and Hypertension, Beth Israel Medical Center, Renal Research Institute, New York, New York; Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Graz, Austria; and Department of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Ontario, Canada

Correspondence: Dr. Frank M. van der Sande, MD, PhD, Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Phone: +31-43-387-5007; Fax: +31-43-387-5006; E-mail: fvs{at}groupwise.azm.nl, f.vd.sande{at}mumc.nl

Background and objectives: Cool dialysate may ameliorate intradialytic hypotension (IDH). It is not known whether it is sufficient to prevent an increase in core temperature (CT) during hemodialysis (HD) or whether a mild decline in CT would yield superior results. The aim of this study was to compare both approaches with regard to IDH.

Design, setting, participants, & measurements: Fourteen HD patients with a history of IDH were studied. During three mid-week HD treatments, CT was set to decrease by 0.5°C ("cooling") or to remain unchanged at the baseline level ("isothermic"). "Thermoneutral" HD (no energy is added to or removed from the patient) was used as a control. Central blood volume (CBV), BP, skin temperature, heart rate variability [low and high frequency] were recorded.

Results: CT increased during thermoneutral and remained respectively stable and decreased during isothermic and cooling. Skin temperature decreased significantly during isothermic and cooling, but not during thermoneutral. Nadir systolic BP (SBP) levels were lower during isothermic and thermoneutral compared with cooling. CBV tended to be higher during cooling compared with isothermic and thermoneutral. Three patients complained of shivering during cooling. Change in LF/HF was not different between cooling, isothermic, and thermoneutral.

Conclusions: IDH may be slightly improved by cooling compared with the isothermic approach, possibly because of improved maintenance of CBV. The hemodynamic effects of mild blood cooling should be balanced against a potentially higher risk of cold discomfort.