The Effect of Dialysate Temperature on Blood Pressure, Core Temperature, and Physical Symptoms in Hemodialysis Patients

Sun Mi Cha; Hye Sook Min

doi:10.7469/KJAN.2017.29.6.604

Journal List > Korean J Adult Nurs > v.29(6) > 1076492

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Cha and Min: The Effect of Dialysate Temperature on Blood Pressure, Core Temperature, and Physical Symptoms in Hemodialysis Patients

Original Research

Korean J Adult Nurs 2017;29(6):604-614.

Published online: 18 December 2017

DOI: https://doi.org/10.7469/KJAN.2017.29.6.604

The Effect of Dialysate Temperature on Blood Pressure, Core Temperature, and Physical Symptoms in Hemodialysis Patients

Sun Mi Cha, MSN, RN¹, Hye Sook Min, Ph.D., RN^2,

^¹Hemodialysis Unit, Bethesda Hospital, Yangsan, Korea

^²Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Min, Hye Sook Department of Nursing, Dong-A University, Daesin Gongwon-ro, Seo-gu, Busan 49201 Korea. Tel: +82-51-240-2872, Fax: +82-51-240-2920, E-mail: hsmin@dau.ac.kr

This study was supported by the research fund from Dong-A University.

Received 2 August 20179 October 2017 Accepted 1 December 2017

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study utilized a randomized block-design for the purpose of studying the effect of dialysate temperature on blood pressure (BP), core temperature, and physical symptoms in hemodialysis patients. The sample was thirty-one patients undergoing hemodialysis assigned to one of three groups. were divided into 3 groups.

Methods

Repeated analysis of variance to number of hypotension occurrences, core temperature changes, and physical symptoms at cool dialysis with dialysate of 35.5°C, standard dialysis with dialysate of 36.5°C and isothermic dialysis based on blood temperature feedback monitor (BTM). Each of the three groups underwent hemodialysis six times at a specific dialysate temperature.

Results

The number of hypotension events were 21 at cool dialysis, 47 at standard dialysis, and 27 at isothermic dialysis, occurrences under cool dialysis were less frequent than under standard dialysis (F=8.08, p=.002). The patients’ core temperature increased by 0.07°C at cool dialysis, 0.21°C at standard dialysis, and 0.18°C at isothermic dialysis, cool dialysis showed a significantly smaller increase in core temperature (F=17.76, p<.001). There was no difference in the incidence of physical symptoms related to dialysate temper-atures (F=2.04, p=.146).

Conclusion

Cool dialysis resulted in a significant prevention of the increase in core temperature and was more effective than standard dialysis in preventing hypotension. Isothermic dialysis had no pos-itive effects in preventing the increase in core temperature or occurrences of hypotension.

Keywords: Renal dialysis, Hemodialysis solutions, Temperature, Blood pressure, Body temperature

REFERENCES

1.Lee YK., Oh JE. Hemodialysis. Korean Journal of Medicine. 2014. 86(2):131–7.

2.ESRD Registry Committee, Korean Society of Nephrology. Current renal replacement therapy in Korea-insan memorial dialysis registry, 2016 [Internet]. Seoul: the Korean Society of Nephrology;2016. [cited 2017 July 10]. Available from. http://www.ksn.or.kr/rang_board/list.html?code=sinchart.

3.Palmer BF., Henrich WL. Recent advances in the prevention and management of intradialytic hypotension. Journal of the American Society of Nephrology. 2008. 19(1):8–11. https://doi.org/10.1681/ASN.2007091006.

4.Ramos R., Soto C., Mestres R., Jara J., Zequera H., Merello JI, et al. How can symptomatic hypotension be improved in hemodialysis patients: cold dialysis vs isothermal dialysis. Nefrologia. 2007. 27(6):737–41.

5.Pack CW. Kidney disease of the month: cardiovascular compli-cations during hemodialysis. Kidney Research and Clinical Practice. 2009. 28(4):385–90.

6.K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. American Journal of Kidney Diseases. 2005. 45(4):S16–153. https://doi.org/10.1053/j.ajkd.2005.01.019.

7.Song JS., Kim ES., Lee YN. The effects of the individual application of low sodium dialysate on weight gain, blood pressure, and intradialytic side effects in patients on maintenance hemodialysis. Journal of Korean Clinical Nursing Research. 2013. 19(1):45–56.

8.Kim HJ. Effects of application of elastic compression stockings on blood pressure, pulse rate and hypotension symptoms in patients with intradialytic hypotension [master's thesis]. Daegu: Catholic University;. 2014. 1–50.

9.Morfin JA., Fluck RJ., Weinhandl ED., Kansal S., McCullough PA., Komenda P. Intensive hemodialysis and treatment complications and tolerability. American Journal of Kidney Diseases. 2016. 68(5):S43–50. https://doi.org/10.1053/j.ajkd.2016.05.021.

10.Kim JA., Yun JH., Jang IS., Lee MS., Hur YS., Shin JH, et al. The effect of gradient ultrafiltration and high sodium dialysate on reducing complications during hemodialysis. Kidney Research and Clinical Practice. 2002. 21(3):450–9.

11.Schneditz D., Levin NW. Keep your temper: how to avoid heat accumulation in haemodialysis. Nephrology, Dialysis, Transplantation. 2001. 16(1):7–9. https://doi.org/10.1093/ndt/16.1.7.

12.Rosales LM., Schneditz D., Morris AT., Rahmati S., Levin NW. Isothermic hemodialysis and ultrafiltration. American Journal of Kidney Diseases. 2000. 36(2):353–61. https://doi.org/10.1053/ajkd.2000.8986.

13.Pérgola PE., Habiba NM., Johnson JM. Body temperature regu-lation during hemodialysis in long-term patients: is it time to change dialysate temperature prescription? American Journal of Kidney Diseases. 2004. 44(1):155–65. https://doi.org/10.1053/j.ajkd.2004.03.036.

14.Lee YJ., Han JJ., Ha SJ., Park MN., Moon JY., Jeong KH, et al. The effect of cool dialysate & sodium profiling on hemodynamics in patients with intradialytic hypotension. Kidney Research and Clinical Practice. 2007. 26(5):567–74.

15.Son MH. Effects of low temperature dalysis on the sleep con-ditions and dialytic stability of hemodialysis patients [master's thesis]. Daegu: Keimyung University;. 2009. 1–64.

16.Azar AT. Effect of dialysate temperature on hemodynamic stability among hemodialysis patients. Saudi Journal of Kidney Diseases and Transplantation. 2009. 20(4):596–603.

17.Woo HJ., Kim IY., Kim MR., Chun AY., Kim SS. The effect of cool temperature dialysate on blood pressure, physical discomfort, dialysis adequacy in hemodialysis patients. The Chung-Ang Journal of Nursing. 2009. 13:41–8.

18.Hussein WF., Schiller B. Dialysate sodium and intradialytic hypotension. Seminars in Dialysis. 2017. 30(6):492–500. https://doi.org/10.1111/sdi.12634.

19.Song WJ., Kim NH., Kim YO., Kim YS., Yoon SA., Yang CW, et al. The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients with low Kt/V. Korean Journal of Nephrology. 2004. 23(1):115–20.

20.Kooman J., Basci A., Pizzarelli F., Canaud B., Haage P., Fouque D, et al. EBPG guideline on haemodynamic instability. Nephrology, Dialysis, Transplantation. 2007. 22(2):22–44. https://doi.org/10.1093/ndt/gfm019.

21.Bossola M., Vulpio C., Tazza L. Fatigue in chronic dialysis patients. Seminars in Dialysis. 2011. 24(5):550–5. https://doi.org/10.1111/j.1525-139X.2011.00956.x.

22.Ayoub A., Finlayson M. Effect of cool temperature dialysate on the quality and patients' perception of haemodialysis. Nephrology, Dialysis, Transplantation. 2004. 19(1):190–4. https://doi.org/10.1093/ndt/gfg512.

23.van der Sande FM., Wystrychowski G., Kooman JP., Rosales L., Raimann J., Kotanko P, et al. Control of core temperature and blood pressure stability during hemodialysis. Clinical Journal of the American Society of Nephrology. 2009. 4(1):93–8. https://doi.org/10.2215/CJN.01800408.

24.Selby NM., McIntyre CW. A systematic review of the clinical effects of reducing dialysate fluid temperature. Nephrology, Dialysis, Transplantation. 2006. 21(7):1883–98. https://doi.org/10.1093/ndt/gfl126.

25.Mustafa RA., Bdair F., Akl EA., Garg AX., Thiessen-Philbrook H., Salameh H, et al. Effect of lowering the dialysate temperature in chronic hemodialysis: a systematic review and meta-analysis. Clinical Journal of the American Society of Nephrology. 2016. 11(3):442–57. https://doi.org/10.2215/CJN.04580415.

26.Toth-Manikowski SM., Sozio SM. Cooling dialysate during in- center hemodialysis: beneficial and deleterious effects. World Journal of Nephrology. 2016. 5(2):166–71. https://doi.org/10.5527/wjn.v5.i2.166.

27.Saxena A., Sharma RK., Gupta A., John MM. Non-invasive me-thod for preventing intradialytic hypotension: a pilot study. Saudi Journal of Kidney Diseases and Transplantation. 2015. 26(5):896–905. https://doi.org/10.4103/1319-2442.164569.

28.Park JY., Hong HS. The effects of cool dialysis on pruritus of chronic renal failure patients. Journal of Korean Biological Nursing Science. 2010. 12(1):31–8.

29.Maggiore Q., Pizzarelli F., Santoro A., Panzetta G., Bonforte G., Hannedouche T, et al. The effects of control of thermal balance on vascular stability in hemodialysis patients: results of the European randomized clinical trial. American Journal of Kidney Diseases. 2002. 40(2):280–90. https://doi.org/10.1053/ajkd.2002.34506.

Table 1.

General Characteristics and Hemodialysis-related Characteristics of Participants (N=31)

Characteristics	Categories	n (%) or M± SD
Gender	Male	21 (67.7)
Gender	Female	10 (32.3)
Age (year)	≤49	5 (16.1)
	50~69	15 (48.4)
	≥70	11 (35.5) 62.06±12.95
Marital status	Married	26 (83.9)
	Single	3 (9.6)
	Divorced/bereaved	2 (6.5)
Current drinking	Ｙ es	8 (25.8)
Current drinking	No	23 (74.2)
Current smoking	Ｙ es	11 (35.5)
Current smoking	No	20 (64.5)
Diseases of cause	Diabetes	15 (48.4)
	Hypertension	8 (25.8)
	CGN	4 (12.9)
	Others	4 (12.9)
Time with HD (month)		51.16±56.57
Duration of each HD (minute)		233.40±16.81
Types of vascular access	AVF	23 (74.2)
Types of vascular access	AVG	8 (25.8)
Starting time of HD	Morning	19 (61.3)
Starting time of HD	Afternoon	12 (38.7)
Taken antihypertensives prior to HD	Yes	24 (77.4)
Taken antihypertensives prior to HD	No	7 (22.6)
Taken vasodilators prior to HD	Yes	4 (12.9)
Taken vasodilators prior to HD	No	27 (87.1)
AVF=arteriovenous fistula; AVG=arteriovenous grafts;

CGN=chronic glomerulonephritis; HD=hemodialysis.

Table 2.

Homogeneity Tests of Three Groups of Dialysate Temperature (N=31)

Variables	A (35.5℃)	B (36.5℃)	C (BTM)	F	p
Variables	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	F	p
SBP (mmHg)	138.82±11.93	140.86±11.69	140.91±10.29	1.31	.276
DBP (mmHg)	70.11±4.65	71.72±5.26	71.99±6.59	1.80	.174
Core temperature (℃)	36.34±0.15	36.32±0.13	36.29±0.11	1.90	.159
Body weight (kg)	61.37±11.21	61.47±11.35	61.63±11.35	2.66	.093
Ultrafiltration volume (L)	1.73±1.33	1.65±0.89	1.79±0.95	0.53	.505

A=cool dialysis; B=standard dialysis; C=isothermic dialysis; BTM=blood temperature feedback monitor; SBP=systolic blood pressure; DBP=diastolic blood pressure.

Table 3.

Comparison of Hypotension Occurrence and Core Temperature according to Dialysate Temperature (N=31)

Variables	A (35.5℃)	B (36.5℃)	C (BTM)	F	p (Bonferroni)
Variables	Frequency of occurrences (M± SD)			F	p (Bonferroni)
Hypotension occurrence	21 (0.11±0.18)	47 (0.25±0.27)	27 (0.15±0.22)	8.08	.002(A＜ B)
Pre HD BT (℃)	36.34±0.15	36.32±0.13	36.29±0.11	1.90
Post HD BT (℃)	36.40±0.14	36.52±0.13	36.47±0.15	12.68
Differences (℃)	0.07±0.13	0.21±0.12	0.18±0.13	17.76	＜.001(A＜ B, A＜ C)

A=cool Dialysis; B=standard dialysis; C=isothermic dialysis; BTM=Blood temperature feedback monitor; HD=hemodialysis; BT=blood core temperature.

Table 4.

Comparison of Physical Symptoms based on Dialysate Temperature (N=31)

Variables	Number of Times	A (35.5℃)	B (36.5℃)	C (BTM)	F	p
Variables	Number of Times	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	F	p
Abdominal discomfort∗	0	29 (93.6)	29 (93.6)	31 (100.0)
Abdominal discomfort∗	1	2 (6.4)	2 (6.4)	0 (0.0)
Yawning∗	0	31 (100.0)	30 (96.8)	31 (100.0)
	1	0 (0.0)	0 (0.0)	0 (0.0)
	2	0 (0.0)	0 (0.0)	0 (0.0)
	3	0 (0.0)	1 (3.2)	0 (0.0)
Nausea∗	0	31 (100.0)	30 (96.8)	31 (100.0)
Nausea∗	1	0 (0.0)	1 (3.2)	0 (0.0)
Muscle cramp∗	0	27 (87.1)	28 (90.3)	28 (90.3)
	1	3 (9.7)	2 (6.5)	3 (9.7)
	2	1 (3.2)	0 (0.0)	0 (0.0)
	3	0 (0.0)	1 (3.2)	0 (0.0)
Dizziness∗	0	31 (100.0)	29 (93.6)	29 (93.6)
Dizziness∗	1	0 (0.0)	2 (6.4)	2 (6.4)
Sweating∗	0	28 (90.3)	29 (93.6)	30 (96.8)
	1	3 (9.7)	0 (0.0)	1 (3.2)
	2	0 (0.0)	1 (3.2)	0 (0.0)
	3	0 (0.0)	1 (3.2)	0 (0.0)
Chills∗	0	0 (0.0)	0 (0.0)	0 (0.0)
Cold∗	0	0 (0.0)	0 (0.0)	0 (0.0)
Occurrence of physical symptoms		0.05±0.10	0.10±0.17	0.04±0.07	2.04	.146

A=cool dialysis; B=standard dialysis; C=isothermic dialysis; BTM=blood temperature feedback monitor; ∗Multiple response.

TOOLS

Similar articles