Effect of cool vs. warm dialysate on toxin removal: rationale and study design

• Published in: BMC nephrology Vol. 16; no. 1; p. 25
• Main Authors: Maheshwari, Vaibhav, Lau, Titus, Samavedham, Lakshminarayanan, Rangaiah, Gade P
• Format: Journal Article
• Language: English
• Published: London BioMed Central 27.02.2015; BioMed Central Ltd
• Subjects: Adult; Aged; Analysis; Clinical Research; Cold Temperature; Female; Follow-Up Studies; Health aspects; Hemodialysis Solutions - therapeutic use; Hot Temperature - therapeutic use; Humans; Internal Medicine; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - therapy; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Nephrology; Prospective Studies; Renal Dialysis - methods; Risk Assessment; Study Protocol; Toxins, Biological - blood; Treatment Outcome; Spent dialysate; Hemodialysis; Inter-compartmental resistance; Cool/Warm dialysate; Dialysate temperature; Toxin removal
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-015-0017-5

Background Cool dialysate is often recommended for prevention of intra-dialytic hypotensive episodes in maintenance hemodialysis (HD) patients. However, its effect on toxin removal is not studied. It is known that inter-compartmental resistance is the main barrier for toxin removal. Cool dialysate can potentially increase this resistance by vasoconstriction and thus impair the toxin removal. The aim of this trial is to compare the toxin removal outcome associated with cool vs. warm dialysate. Method/design This study is based on the hypothesis that dialysate temperature, a potential maneuver to maintain hemodynamic stability during HD, may influence inter-compartmental resistance and hence, toxin removal. Only stable HD patients will be recruited for this study. The quantum of removed toxins will be assessed by the total spent dialysate, which is a gold standard to quantify the efficacy of a single dialysis session. Collected samples will be analyzed for urea, creatinine, phosphate, β 2 -microglobulin, and uric acid. The study is a single center, self-controlled, randomized prospective clinical research where 20 study subjects will undergo 2 dialysis sessions: (a) cool dialysis with dialysate at 35.5°C, and (b) warm dialysis with dialysate at 37°C. Pre- and post-dialysis blood samples will be collected to quantify the dialysis adequacy and toxin reduction ratio. Discussion This is the first clinical research to investigate the effect of dialysate temperature on removal of both small and large-sized toxins. Successful completion of this research will provide important knowledge pertaining to dialysate temperature prescription. Results can also lead to the hypothesis that cool dialysate may help in by preventing intra-dialytic hypotensive episodes, but prolonged prescription of cool dialysate may lead to comorbidities associated with excess toxin accumulation. The new knowledge will encourage for personalized dialysate temperature profiling. Trial registration Clinicaltrials.gov Identifier - NCT02064153 .