Individualised dialysate temperature improves intradialytic haemodynamics and abrogates haemodialysis-induced myocardial stunning, without compromising tolerability.

Abstract

BACKGROUND/AIMS: Haemodialysis-induced myocardial stunning is associated with intradialytic hypotension, increased likelihood of cardiovascular events and death. Dialysis at 35°C reduces stunning, but adverse thermal symptoms limit technique adoption. This study investigated whether individualised body temperature dialysis improves haemodynamic stability and abrogates stunning. METHODS: Randomised crossover study of 11 patients compared LV regional wall motion abnormalities (RWMAs) at 37°C (HD(37)) and body temperature ('individualised', HD(ind)). Regional systolic function was quantitatively assessed by echocardiography. Haemodynamics were assessed using continuous pulse wave analysis. Thermal symptoms were scored by questionnaire. RESULTS: Mean predialysis body temperature was 36.0 ± 0.1°C. Mean number of peak stress RWMAs per patient was lower with HD(ind) (3.9 ± 1.4 vs. 5.3 ± 1.5, p = 0.03). Intradialytic systolic BP was higher during HD(ind) versus HD(37) (p < 0.001). Individualised body temperature dialysis demonstrated symptomatic tolerability comparable to HD(37). CONCLUSIONS: Individualised-temperature haemodialysis abrogates stunning, providing effective haemodynamic stabilisation at no additional therapy cost.