Cold dialysate decreases intradialytic hypotension in hemodialysis patients without improving nutritional and inflammatory status

This study, "Could cooling dialysate improve inflammatory and nutritional status of hemodialysis patients?" is led by Asmaa Elemshaty and is published in BMC Nephrology.

Reducing the dialysate temperature to 0.5 °C below central body temperature (dialysate cooling) decreases the likelihood of intradialytic hypotension. However, other factors affecting hemodialysis patients have not been thoroughly investigated. This research aimed to evaluate the impact of individualized dialysate cooling on nutritional and inflammatory parameters in chronic hemodialysis (HD) patients in 70 patients. It divided them into control and intervention groups. The standard dialysate temperature in the control and intervention group was 37 °C and 0.5 °C below core body temperature, respectively. MIS score was calculated.

The study results could be summarised as:

• Following six months of dialysate cooling, intradialytic hypotension episodes were reduced in the intervention group.
• Following dialysate cooling, there was a decrease in Serum ferritin, transferrin saturation (TSAT), high sensitive C-reactive protein (HS-CRP), and Interleukin-6 (IL-6).
• IL-6 dropped, but serum ferritin, TSAT, albumin, and HS-CRP rose in the control group.
• There was a drop in levels of haemoglobin In both groups.
• There was an increase in erythrocyte sedimentation rate (ESR) in both groups' midarm muscle circumference, and MIS worsened.

They said Cold dialysate decreased intradialytic hypotension with no significant improvement in nutritional and inflammatory surrogates.

Long-duration studies, including many patients, should be conducted to adequately assess its effect on inflammation and nutrition in chronic hemodialysis patients.

This study had limitations like a small number of patients, short duration, failure to control the trivial events, etc.

Cool dialysate for hemodialysis patients is safe and feasible, though it protected the patient from intra-dialytic hypotension but was not associated with better nutrition or inflammation.

Further reading:

Elemshaty, A., Sayed-Ahmed, N., Mesbah, A. et al. Could cooling dialysate improve the inflammatory and nutritional status of hemodialysis patients? BMC Nephrol 24, 255 (2023). https://doi.org/10.1186/s12882-023-03305-z