Document Detail


Control of core temperature and blood pressure stability during hemodialysis.
MedLine Citation:
PMID:  18842948     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 degrees 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.
Authors:
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; Nathan W Levin
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2008-10-08
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  4     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-14     Completed Date:  2009-04-10     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  93-8     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands. fvs@groupwise.azm.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure*
Blood Volume
Body Temperature Regulation*
Cold Temperature* / adverse effects
Cross-Over Studies
Energy Metabolism
Female
Heart Rate
Hemodialysis Solutions* / adverse effects
Humans
Hypotension / etiology,  physiopathology,  prevention & control*
Male
Middle Aged
Renal Dialysis* / adverse effects
Shivering
Skin Temperature
Chemical
Reg. No./Substance:
0/Hemodialysis Solutions
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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