Hemodialysis with Low-Temperature Dialysate: A Long-Term Experience

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Abstract
The effect of cool dialysate in hemodialysis (HD)-induced symptoms was studied in a group of 8 patients, neither diabetc nor anephric, with a high incidence of HD-induced hypotension (20–90%). Patients were studied during two consecutive periods of 6 months, the first one with dialysate at 37°C (598 sessions) and the second one at 35 °C (599 sessions). Dialysis at low temperature was associated with a decrease in symptomatic hypotension (SH) (47.4 vs. 33.9%, p < 0.001), a greater loss of weight during HD (1.52 ± 0.03 vs. 1.71 ± 0.03 kg, p < 0.001) and stabilization of predialysis systolic blood pressure (SBP) at a lower level (144 ± 0.69 vs. 139 ± 0.98 mm Hg, p < 0.001). At 37 °C, SH was associated with a higher ultrafiltration (1.71 ± 0.05 vs. 1.32 ± 0.05 kg, p < 0.001). There was an improvement of symptoms both taken as a whole (55.6 vs. 45.8%, p < 0.01) or one by one, cramps were the only exception as they increased at 35 °C (2.7 vs. 10.9%, p < 0.001) being related with a greater weight loss at both temperatures (1.47 ± 0.04 vs. 2.04 ± 0.25 kg at 37°C·p < 0.001; 1.76 ± 0.03 kg vs. 2.23 = 0.10 kg at 35°C, p < 0.001). In spite of the increase in the frequency of cramps, 7 out of 8 patients experienced some amelioration of dialysis symptoms (range between 7 and 21.4%). Dialysis at low temperature represents a simple, low-cost and partially effective method, which either by itself or associated with other procedures may contribute to the well-being of HD patients.