Kuhlmann U, Hermann W, Schwickeardi M, Pahl C, Peternely O,
Kramer M, Lange H
Influence of thermal energy flow between dialysate and blood on
body temperature, blood pressure, and vasoactive hormones
during haemodialysis
22nd ESAO Congress (Eur Soc Artif Organs)
Int J Artif Organs
(Oct) 18:424 1995
The benefits of reducing dialysate temperature slightly on intradialytic
blood pressure are well known, although some patients are uncomfortable due
to shivering. Fresenius has come up with a module that monitors inflow and
outflow blood temperature as well as dialysate temperature which allows the
operator to maintain blood temperature constant, or to add or subtract a
certain amount of heat at will.
In this study, 28 patients were dialyzed in 4 ways: (1) standard (37 degrees
C), (2) positive energy flow (PEF), (3) negative energy flow (NEF), and (4)
maintenance of initial blood temperature (MIBT). To maintain initial blood
temperature, a negative energy flow (heat subtraction) was required. MAP
tended to be higher with the MIBT or NEF methods (both with heat subtraction)
than with PEF (heat addition), but the values were not statistically
different. With standard dialysis, body temperature rose by 0.5 degrees C,
and was only slightly higher with PEF, presumably due to activation of
compensatory heat loss mechanisms. There were no differences in plasma
levels of vasoactive hormones, including ANP, endothelin, epinephrine, renin,
aldosterone, and cortisol.
Comment: This is a nice study, albeit the lack of significant changes
in MAP with cool dialysate is a bit surprising, and not consistent with
reports by others (using admittedly more primitive means of varying heat gain
and loss). The results suggest that something during dialysis causes the
patient to warm. Whether this is ultrafiltration-induced reduction in skin
blood flow, reducing heat loss, or some increase in heat generation, is not
clear (but see accompanying abstract by Lange et al
presented at the same meeting).
(J. Daugirdas)
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22nd ESAO Congress (Eur Soc Artif Organs)
Basic hemodialysis :
Complications (acute)