TERMAL BALANCE MANAGEMENT FOR INTRADIALYSIS HYPOTENSION PREVENTION
https://doi.org/10.15825/1995-1191-2012-4-59-64
Abstract
Intradialytic hypotension (IDH) remains an important cause of morbidity and mortality in chronic hemodialysis (HD) patients and can be ameliorated by low temperature HD. Biofeed-back temperature-control device BTM® (Fresenius Medical Care, Germany) was used for precision temperature measurement and to deliver isothermic (ITD) or thermoneutral (TND) dialysis. At stage one 24 stable dialysis patients were studied in terms of inlet blood temperature (IBT) variation during sessions with normal (36,5 °С-ND) and cold dialysate (35 °С-CD). IBT was increasing in both cases however the increase was significantly lower in CD. At stage two, 18 patients underwent programmed cooling during two ITD and two TND sessions. In TND high correlation (r = 0.66; р < 0.05) was observed between IBT increase and ultrafiltration rate. Keeping IBT stable during ITD required cons- tant decrease of dialysate temperature to 34.9 ± 0.2 °С at the end of session. At stage three, 19 IDH-prone patients were displaced from regular dialysis program to ITD. As a result,the decrease overall rate of IDH from 36.2 ± 1.1% to 11.3 ± 4,6% was observed. Conclusions: 1. The main mechanism of body temperature raise during HD is heat retention secondary to the compensatory response to loss of plasma volume, resulting in increase of the total peripheral resistance. 2. CD is effective for IDH prevention. 3. ITD is the optimal version of CD.
About the Authors
A. G. Strokov
Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs,
I.M. Sechenov First Moscow State Medical University, Department of transplantology and artificial organs
Russian Federation
Russian Federation
Y. L. Poz
Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs,
I.M. Sechenov First Moscow State Medical University, Department of transplantology and artificial organs
K. N. Kryshin
Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs,
I.M. Sechenov First Moscow State Medical University, Department of transplantology and artificial organs
References
1. Bennett L.A., Johnson J.M., Stephens D.P. et al. Evi- dence for a role for vasoactive intestinal peptide in active vasodilatation in the cutaneous vasculature of humans // J. Physiol. 2003. Vol. 552. P. 223–232.
2. Burton J.O., Jefferies H.J., Selby N.M., McIntyre C.W. Hemodialysis-Induced Cardiac Injury: Determinants and Associated Outcomes // Clin. J. Am. Soc. Nephrol. 2009. Vol. 4 (5). P. 914–920.
3. Chesterton L.J., Selby N.M., Burton J.O., McIntyre C.W. Cool dialysate reduces asymptomatic intradialytic hypo- tension and increases baroreflex variability // Hemodial. Int. 2009. Vol. 13(2). P. 189–196.
4. Coli U., Landini S., Lucatello S. et al. Cold as cardiova- scular stabilizing factor in hemodialysis: hemodynamic evaluation // Trans. Am. Soc. Artif. Intern. Organs 1983. Vol. 29. P. 71–75.
5. DOQI. Clinical Practice Guidelines. Hemodialysis Ade- quacy // Am. J. Kidney Dis. 1997. Vol. 30 [Suppl 2]. S. 50–51.
6. Donauer J., Böhler J. Rationale for the use of blood vo- lume and temperature control devices during hemodialy- sis // Kidney Blood Press. Res. 2003. Vol. 26. P. 82–89.
7. Donauer J., Schweiger C., Rumberger B. et al. Reduc- tion of hypotensive side effects during online-haemodia- filtration and low temperature haemodialysis // Nephrol. Dial. Transplant. 2003. Vol. 18. P. 1616–1622.
8. European Best Practice Guideline for Haemodialysis Part 2 // Nephrol. Dial. Transplant. 2007. Vol. 22 [Sup- pl 2]. ii36–ii37.
9. Gotch F.A., Keen M.L., Yarian S.R. An analysis of ther- mal regulation in hemodialysis with one and three com- partment models // ASAIO Trans. 1989. Vol. 35. P. 622– 624.
10. 21.
11. 23. 24.
12.
13. Hsu H.-J., Yen C.-H., Hsu K.-H. et al. Association bet- ween cold dialysis and cardiovascular survival in he- modialysis patients // Nephrol. Dial. Transplant. 2012. Vol. 27 (6). P. 2457–2464.
14. Jefferies H.J., Burton J.O., McIntyre C.W. Individualised dialisate temperature improves intradialytic haemodyna- mics and abrogates haemodialysis-induced myocardial stunning, without compromising tolerability // Blood Purif. 2011. Vol. 32 (1). P. 63–68.
15. Johnson J.M., Proppe D.W. Handbook of Physiology // Fregly M.J., Blatteis C.M., eds. Section 4: Environmen- tal Physiology. Oxford University Press, New York, NY. 1996. P. 215–243.
16. Jost C.M., Agarwal R., Khair-el-Din T. et al. Effects of cooler temperature dialysate on hemodynamic stability in ‘problem’ dialysis patients // Kidney Int. 1993. Vol. 44 (3). P. 606–612.
17. Lindholm T., Thysell H., Yamamoto Y. et al. Temperature and vascular stability in hemodialysis // Nephron 1985. Vol. 39. P. 130–133.
18. Maggiore Q., Enia G., Catalano C. et al. Studies on hemodialysis hypertermia// Blood Purif. 1984. Vol. 2. P. 125–129.
19. Maggiore Q., Pizzarelli F., Santoro A. et al. The effects of control of thermal balance on vascular stability in he- modialysis patients: Results of the European randomized clinical trial // Am. J. Kidney Dis. 2002. Vol. 40. P. 280– 290.
20. Maggiore Q., Pizzarelli F., Zoccali C. et al. Effect of ex- tracorporeal blood cooling on dialytic arterial hypoten- sion // Proc. Eur. Dial. Transplant. Assoc. 1981. Vol. 18. P. 597–602.
21. Passlick-Deetjen J., Bedenbender-Stoll E. Why thermo- sensing? A primer on thermoregulation // Nephrol. Dial. Transplant. 2005. Vol. 20. P. 1784–1789.
22. Pizzarelli F. From cold dialysis to isothermic dialysis: a twenty-five year voyage // Nephrol. Dial. Transplant. 2007. Vol. 22. P. 1007–1012.
23. Pizzarelli F., Sisca S., Zoccali C. et al. Blood tempera- ture and vascular stability in hemofiltration // Int. J. Artif. Organs 1983. Vol. 6. P. 37–41.
24. Rowell L.B. Cardiovascular adjustments of thermal stress // Sheperd J., Abboud F., eds. Handbook of Phy- siology. American Physiological Society, Bethesda MD: 1983. P. 967–1024.
25. Selby N.M., McIntyre C.W. A systematic review of the clinical effects of reducing dialysate fluid temperature // Nephrol. Dial. Transplant. 2006. Vol. 21. P. 1883–1898. 23. Usvyat L., Kotanko P., van der Sande F. et al. Circadian variations in body temperature during dialysis // Neph- rol. Dial. Transplant. 2012. Vol. 27 (3). P. 1139–1144
26. Van der Sande F.M., Wystrychowski G., Kooman J.P. et al. Control of core temperature and blood pressure sta- bility during hemodialysis // Clin. J. Am. Soc. Nephrol. 2009. Vol. 4. P. 93–98.
27. Wenger C.B. Medical aspects of harsh environments. 2001. Vol. 1. P. 51–86.
Review
For citations:
Strokov A.G., Poz Y.L., Kryshin K.N. TERMAL BALANCE MANAGEMENT FOR INTRADIALYSIS HYPOTENSION PREVENTION. Russian Journal of Transplantology and Artificial Organs. 2012;14(4):59-64. (In Russ.) https://doi.org/10.15825/1995-1191-2012-4-59-64
Views:
884
Email this article 