TY - JOUR
T1 - Body temperature regulation during hemodialysis in long-term patients
T2 - Is it time to change dialysate temperature prescription?
AU - Pérgola, Pablo E.
AU - Habiba, Nusrath M.
AU - Johnson, John M.
N1 - Funding Information:
Supported in part by grants form the South Texas Veterans Health Care System, American Heart Association Texas Affiliate, NIDDK (George O'Brien Kidney Research Center Grant), and NIH (HL59166).
PY - 2004/7
Y1 - 2004/7
N2 - 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.
AB - 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.
KW - Dialysate temperature
KW - blood temperature monitor
KW - body temperature
KW - hemodialysis (HD)
UR - http://www.scopus.com/inward/record.url?scp=3042730145&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2004.03.036
DO - 10.1053/j.ajkd.2004.03.036
M3 - Article
C2 - 15211448
AN - SCOPUS:3042730145
SN - 0272-6386
VL - 44
SP - 155
EP - 165
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 1
ER -