Effect of dialysate temperature on intradialytic hypotension

Abstract

BACKGROUND: The aim of the study was to determine whether lowering the dialysate temperature in hemodialysis patients would result in a decreased frequency of intradialytic hypotension. METHODS: Dialysate temperature was lowered by 0.5°C increments in seven hypotension-prone hemodialysis patients. The primary outcomes, measured over 12 weeks, included systolic blood pressure less than 90 mmHg, an interruption in ultrafiltration due to hypotension, and whether target fluid loss was achieved. RESULTS: Dialysate temperature was lowered by a total of 0.5°C in four patients and 1.0°C in three patients. Results are presented as odds ratios for every 0.5° decrease in dialysate temperature. The odds of systolic blood pressure dropping to below 90 mmHg and the odds that ultrafiltration would be interrupted due to hypotension were lowered to 0.30 and 0.91 times the odds with a higher dialysate temperature (p < .0001 and p = .0074, respectively). The odds of achieving target fluid loss were 3.60 times greater with a lower dialysate temperature (p < .0001). DISCUSSION: A reduction in dialysate temperature by as little as 0.5-1.0°C had a significant effect on intradialytic hypotension in this patient population. We feel that this represents a practical and effective method for managing intradialytic hypotension in hypotension-prone dialysis patients.