Body temperature regulation during hemodialysis in long-term patients: Is it time to change dialysate temperature prescription?

Pablo E. Pérgola, Nusrath M. Habiba, John M. Johnson

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


During hemodialysis procedures, changes in the dialysate temperature can raise or lower body temperature because the blood is returned to the patient in thermal equilibrium with the dialysate. Even a dialysate temperature equal to the patient's body temperature as measured from the tympanic membrane, oral cavity, or axilla can result in an increase in the patient's body temperature, leading to cutaneous vasodilation and the potential for cardiovascular instability and hypotension. This deleterious cycle of events can be prevented by suitably adjusting the dialysate temperature. Lowering the dialysate temperature from 37°C to 34-35.5°C has improved the cardiovascular stability of many hemodialysis patients. Continuous monitoring of blood temperature allows the practitioner to make preemptive changes in dialysate temperature because a small change in body temperature can have enormous cardiovascular implications. For example, only 0.3°C to 0.8°C separates the thresholds for skin vasodilation from that for shivering. A suggested improvement in the hemodialysis procedure is to use devices that allow continuous monitoring of arterial and venous blood temperatures and adjust the dialysate temperature automatically, keeping the patient, not the dialysate, isothermic. Less optimal solutions appear to be (1) to monitor arterial and venous temperatures while manually adjusting the dialysate temperature to maintain arterial (and hence body) temperature stability; (2) to monitor peripheral temperatures (oral, tympanic) at regular intervals and adjust dialysate temperature to maintain the body temperature constant; (3) routinely use a dialysate temperature <37.0°C in all patients unless contraindicated.

Original languageEnglish
Pages (from-to)155-165
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number1
StatePublished - Jul 2004


  • Dialysate temperature
  • blood temperature monitor
  • body temperature
  • hemodialysis (HD)


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