Abstract
Dialysate cooling, either individualized based upon patient body temperature, or to a standardized temperature below 37 °C, has been proposed to minimize hemodynamic insults and improve outcomes among hemodialysis patients. However, low dialysate temperatures (35–35.5 °C) are associated with patient discomfort, and individualized dialysate cooling is difficult to operationalize. Here, we tested whether a standardized dialysate temperature of 36 °C (dT36) was associated with improved clinical outcomes compared to the default temperature of 37 °C (dT37). Because patients with known hemodynamic instability may be selectively prescribed dT36, we minimized selection bias by considering only incident adult in-center hemodialysis patients who, between Jan 2011 and Dec 2013 received their first-ever hemodialysis treatment at a large dialysis organization. Exposure status was based on the treatment order for this first-ever treatment. 313 dT36 patients were identified and propensity-score matched (1:5) to 1565 dT37 controls. Death, hospitalization, and missed hemodialysis treatments were considered from the date of first-ever hemodialysis treatment until the earliest of death, loss to follow-up, crossover (month in which prescribed dialysate temperature was consistent with patient’s exposure group for <80% of treatments), or study end (June 2015). During follow-up, rates of death, hospitalization and missed hemodialysis treatments did not differ between the two groups. This study therefor showed no benefit of dT36 vs. dT37 with respect to these clinical outcomes. Our results do not favor conversion to a default dialysate temperature of 36 °C. Individualized dialysate cooling may provide a more reliable approach to achieve the hemodynamic benefits associated with reduced dialysate temperature.
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Acknowledgements
The authors wish to acknowledge all members of the Healthcare Analytics and Insights team for their assistance and helpful discussions. This study was funded by DaVita Inc. Data from this study was presented in abstract and poster form at ASN Kidney Week 2016.
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This study was supported by DaVita, Inc. KSG, DEC, and SMB are employees thereof. DaVita, Inc had no role in study design; collection, analysis, and interpretation of data; nor writing the report. DaVita, Inc was involved in the decision to submit the report for publication and was provided a draft of the manuscript for review prior to submission. None of the authors have any financial disclosures. SMB’s spouse is an employee of AstraZeneca.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.
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Gray, K.S., Cohen, D.E. & Brunelli, S.M. Dialysate temperature of 36 °C: association with clinical outcomes. J Nephrol 31, 129–136 (2018). https://doi.org/10.1007/s40620-016-0369-3
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DOI: https://doi.org/10.1007/s40620-016-0369-3