Speaker: Center-wide cooler dialysate should not be implemented
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ORLANDO — Due to limited benefits and a high likelihood of patient discomfort, a presenter at ASN Kidney Week recommended dialysis centers do not adopt center-wise cooler dialysate policies.
“Adopting cooler dialysate as a center-wide policy, as done in some centers, allows for easier implementation, has the potential to benefit most patients as intradialytic hypertension cardiovascular disease is common and it's consistent with the eligibility criteria [of] prior trials,” Amit X. Garg, MD, PhD, from London Health Sciences Centre, said in the presentation. He added, “The drawback of a cooler dialysate with a fixed temperature for all patients is that several shiver and feel uncomfortably cold especially when their pre-dialysis body temperature is higher than the set-dialysis temperature.”
In a pragmatic, two-arm, parallel-group, registry-based, open-label, cluster-randomized trial (MyTemp), researchers randomized 84 centers to use either a personalized cooler dialysate set 0.5°C to 0.9°C below each patient’s measured pre-dialysis body temperature, with a lowest recommended dialysate temperature of 35.5°C, or standard-temperature dialysate set to 36.5°C for all patients and treatments. A total of 15,413 patients received care during the trial.
During the study period from April 2017 to March 2021, researchers considered the primary outcome the composite of cardiovascular-related death or hospital admission with myocardial infarction, ischemic stroke or congestive heart failure.
Researchers identified 35.8°C as the mean dialysate temperature in the cooler dialysate group compared with 36.4°C in the standard-temperature group. Overall, patients were more likely to report being uncomfortably cold on dialysis in the cooler dialysate group.
The primary outcome occurred in 21.4% of the cooler dialysate group vs. 22.4% of the standard-temperature group. However, the center-wide policy of personalized cooler dialysate vs. standard-temperature dialysate did not significantly reduce the risk of major cardiovascular events.
Additionally, the mean drop in intradialytic systolic blood pressure was 26.6 mmHg vs. 27.1 mmHg, respectively.
“For a nephrologist, such as myself, who currently uses cooler dialysate individualized patient care, my test results provide an opportunity to reflect on practice. If I do prescribe cooler dialysate for certain patients, such as those with refractory intradialytic hypertension, I plan to do so more carefully and monitor how well that's tolerated. I certainly would be more confident about its use in such patients in future, well conducted, multicenter trials with restricted eligibility, so the benefits outweigh the risks. Finally for researchers, the experiences we developed with innovative design elements in MyTemp may help streamline future lifestyles and testing interventions to improve kidney care.”
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Garg AX, et al. FR-OR66. Presented at: ASN Kidney Week; Nov. 3-6, 2022; Orlando (hybrid meeting).
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