Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

Abstract

The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension (IDH). IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and efficacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37 °C. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confirm the encouraging outcomes mentioned here.

Keywords: Hemodialysis, Dialysate temperature, Cool dialysate, Intradialytic hypotension, Hypotensive episodes, Hemodynamic stability, Cool temperature dialysis

Core tip: Cooled dialysate is commonly employed to reduce the incidence of intradialytic hypotension (IDH) in patients on chronic dialysis. The studies to date that have evaluated cooled dialysate are limited by small sample size and it has not become the standard of care for managing IDH. However, the small studies that exist are promising and suggest that cooling dialysate improves hemodynamic tolerability of dialysis, minimizes IDH, and exerts a protective effect over major organs including the heart and brain. More studies are needed to assess the long-term effects of cooling dialysate in this population.