THE PROTECTIVE EFFECT OF COOL DIALYSATE IS DEPENDENT ON PATIENTS PREDIALYSIS TEMPERATURE

A significant proportion of hemodialysis patients have subnormal body temperature, Dialysis against cool dialysate has been frequently shown to reduce the incidence of symptomatic hypotension (SH), although onl y one of these reports included patient temperatures. Our hypothesis w as that the response to cool or normal temperature dialysis could depe nd on a patient's baseline temperature, Of 128 patients in two hemodia lysis units, 28 had a (mean of 5) baseline temperature less than 36 de grees C and 48 patients had a temperature higher than 36.5 degrees C. A crossover study was performed by dialyzing patients for 10 consecuti ve treatments with the same dialysate temperature, either 37 degrees C or 35 degrees C. All patients combined had a significant reduction in SH with 35 degrees C dialysate, 11.2% versus 5.5% with 37 degrees C d ialysate (P = 0.001), The incidence of SH in euthermic patients was no t affected by dialysate temperature, Hypothermic patients dialyzed aga inst 37 degrees C dialysate had the highest incidence of SH, which dec reased markedly with 35 degrees C dialysate (15.9% v 3.4%; P = 0.0001) , There were no differences in age, duration of dialysis, gender, hemo globin, urea, creatinine, or volume removed per dialysis between the t wo groups. In conclusion, subnormal temperature is common in dialysis patients but the etiology is unclear, The hemodynamic protective effec t of cool dialysate only occurs in patients with subnormal temperature s, Only the subpopulation of patients with SH and low body temperature should be dialyzed against cool dialysate. (C) 1996 by the National K idney Foundation, Inc.