Key result
Cold hemodialysis maintains stable mean arterial pressure and delays ANP reduction compared to warmer dialysate.
Why the study?
The mechanisms underlying better cardiovascular stability with cold dialysate during hemodialysis and its effects on plasma atrial natriuretic peptide levels are unknown.
Does cold hemodialysis improve hemodynamic stability and alter plasma ANP levels compared to normal or warm hemodialysis in stable hemodialysis patients?
Does cold hemodialysis improve hemodynamic stability and alter plasma ANP levels compared to normal or warm hemodialysis in stable hemodialysis patients?
p-value: p=<0.05
Cold hemodialysis helps maintain hemodynamic stability in hemodialysis patients, potentially related to a delayed decrease in plasma ANP levels.
Cold dialysate stabilizes intradialytic BP with delayed ANP decline; leaves open alternative mechanisms and requires confirmation in larger trials.
The high plasma levels of the vasodilating hormone atrial natriuretic peptide (alpha-ANP), observed in patients with chronic renal failure, decrease substantially during hemodialysis (HD), probably owing to volume reduction. Cardiovascular stability is better maintained by the use of cold dialysate although underlying mechanisms are unknown. In order to investigate the effects of different dialysate temperatures on hemodynamic stability and plasma levels of immunoreactive ANP (p-irANP), 10 stable HD patients were dialyzed with bicarbonate dialysis fluid for 240 min with each of 3 different dialysate temperatures: 36.5 degrees C (normal HD; NHD), 38.5 degrees C (warm HD; WHD) and 34.5 degrees C (cold HD; CHD). A Cuprophan plate dialyzer was used. The ultrafiltration volume and ultrafiltration rate were identical in each patient during the treatments. p-irANP was determined by radioimmunoassay, using 2 antisera which different cross-reactivity to ANP-related peptides. During NHD a nonsignificant decrease in mean arterial blood pressure from 111 +/- 5 to 103 +/- 8 mm Hg was observed. A significant (p < 0.05) decrease in mean arterial blood pressure from 109 +/- 4 to 96 +/- 6 mm Hg occurred during WHD, while during CHD it remained stable (111 +/- 4 before, 112 +/- 5 mm Hg after). Irrespective of the dialysate temperature or the antiserum used, p-irANP decreased significantly (p < 0.05) during the treatment. The reduction in p-irANP was delayed during CHD, the decrease being significantly (p < 0.05) less pronounced after 120 min. At the end of the treatment no significant difference was observed between the regimes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Hegbrant et al. (2008) studied Chronic renal failure requiring hemodialysis (n=10). Cold hemodialysis vs. Normal (36.5 degrees C) and warm (38.5 degrees C) hemodialysis was evaluated on Mean arterial blood pressure and plasma levels of immunoreactive ANP (p=<0.05). Cold hemodialysis maintained stable mean arterial blood pressure (111 to 112 mm Hg) and delayed the decrease in plasma atrial natriuretic peptide compared to normal or warm hemodialysis.
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