Key result
Cooled dialysate improves preservation of residual kidney function by ~52% versus standard dialysate.
Why the study?
Whether dialysate cooling can preserve residual kidney function in incident hemodialysis patients without baseline intradialytic hypotension was unknown.
Does cooled hemodialysis preserve residual kidney function in incident hemodialysis patients without baseline intradialytic hypotension?
RCT (n=100)
randomly assigned
Does cooled hemodialysis preserve residual kidney function in incident hemodialysis patients without baseline intradialytic hypotension?
Hazard Ratio: 0.478 (95% CI 0.23–0.89)
Absolute Event Rate: 6.2% vs 4.6%
p-value: p=0.044
In incident hemodialysis patients without baseline intradialytic hypotension, cooled dialysate significantly preserved residual kidney function over 12 months compared to standard temperature.
Cooled dialysate may preserve RKF in incident HD without baseline IDH; leaves open need for larger trials before practice change.
Background/aim Emerging evidence on lowering dialysate temperature suggests a cardiorenal protective effect of dialysate cooling (CD) against dialysis-induced ischemia in hemodialysis (HD) patients prone to intradialytic hypotension (IDH). Whether this benefit of CD could be extended to incident HD populations without baseline IDH to preserve residual kidney function (RKF) is unknown. Patients and methods One hundred incident HD patients were randomly assigned to receive either incremental CD less than or equal to 36°C (intervention, N=50 patients) or standard-temperature (ST) dialysate (control, N=50 patients) for 12 months. The primary endpoint was to test the safety and efficacy of CD to preserve RKF. Results By the end of 12 months, CD patients showed less decline in estimated glomerular filtration rate compared with standard-temperature patients (6.2 vs. 4.6 ml/min/1.73 m2, P=0.025); in addition, Cox regression analysis showed that CD was an independent variable for the preservation of RKF (P=0.044, hazard ratio: 0.478, confidence interval: 0.23–0.89). CD was well tolerated, with less fatigue and IDH; however, coldness, shivering, and discomfort were significantly higher in the CD group. Conclusion In incident HD patients without baseline IDH, cooled dialysis might help preserve RKF with a reasonable safety profile. Further studies are warranted to explore these findings.
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Ibrahim et al. (2021) conducted an RCT in Incident hemodialysis without baseline intradialytic hypotension (n=100). Cooled dialysate vs. Standard-temperature dialysate was evaluated on Preservation of residual kidney function (HR 0.478, 95% CI 0.23-0.89, p=0.044). Cooled dialysate improved the preservation of residual kidney function compared to standard-temperature dialysate in incident hemodialysis patients (HR 0.478; 95% CI 0.23-0.89; P=0.044).
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