Abstract: TH-OR008

Individualized Cool Dialysate as an Effective Therapy for Intradialytic Hypotension

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Bullen, Alexander, UCSD, San Diego, California, United States
  • Rifkin, Dena E., UCSD, San Diego, California, United States
  • Trzebinska, Danuta, UCSD Medical Center, SAN DIEGO, California, United States
Background

Intradialytic hypotension (IDH) is the most common dialytic complication identified in 15-20% of all dialysis encounters. Cool dialysate by promoting peripheral vasocontriction leads to decreased IDH and may be an effective approach to reduce IDH. However, only small studies have been done to date using a cool dialysate and they have not typically used an individualized cool dialysate temperature. Therefore, we designed a study to determine if cool dialysate would decrease the number of episodes of IDH in a high-comorbidity dialysis population served within our hospital.

Methods

We conducted a single center study at the UCSD dialysis unit. Baseline characteristics were obtained from the electronic medical record including age, race, and co-morbidities. The study consisted of baseline and intervention phases, with patients serving as their own controls. In the first phase, core baseline temperature (CBT) was determined as an average of oral temperature prior to three sessions of hemodialysis. During this phase hemodynamic parameters during dialysis were recorded for 6 HD sessions. In the second phase, the CBT was then decreased by 0.5 degrees Celsius and hemodynamic parameters were then collected again for 6 more HD sessions. Parameters during the control phase and cool phase were compared.

Results

93 participants with mean age was 56.7±1.5 were included. 53% were women, and 53.8% were Hispanic. The average years on HD were 4.7±0.5 years. The number of IDH episodes between the control and the cool phase, decreased significantly (P<0.001) from 3.27±0.29 per patient to 1.96±0.23. The lowest recorded intradialytic MAP increased from 78.22±1.60 mmHg to 85.60±1.20 mmHg, the mean increase was of 4.75±2.12 (P=0.028). No correlation was found between a change in UF and improved hemodynamics (P=0.22). Adequacy of HD (Kt/v) did not change significantly (P=0.75).

Conclusion



Individualized cool dialysate is an effective and easy to implement method to decrease intradialytic hypotension and it may ameliorate clinical symptoms and ease nursing burden in patients with frequent IDH.

BP (mm Hg)Control phaseCool Dialysate phaseMean DifferenceP-value
Pre-HD (standing)
-SBP
-DBP
-MAP
149.9
80.41
103.6
155.5
81.9
106.4
5.59
1.48
2.85
0.15
0.54
0.25
Pre-HD (sitting)
-SBP
-DBP
-MAP
149.3
79.8
103.1
155.3
83.0
107.1
6.01
3.24
4.02
0.08
0.12
0.06
Lowest Intradialytic Pressure
-SBP
-DBP
-MAP
106.3
63.2
78.2
112.6
75.9
85.6
6.3
4.0
4.8
0.03
0.04
0.03
Post-HD (standing)
-SBP
-DBP
-MAP
125.5
69.25
88.0
138.5
75.9
96.7
13.0
6.6
8.7
<0.001
0.001
<0.001
Post-HD (sitting)
-SBP
-DBP
-MAP
132.7
72.9
92.9
140.4
76.2
97.6
7.6
3.3
4.8
0.02
0.09
0.02