The effect of cooled dialysate on thermal energy balance in hemodialysis patients

The authors have monitored extracorporeal thermal energy balance using continuous in-line arterial and venous temperature and blood flow measurements. Use of dialysate at 37 degrees C resulted in a mean heat energy gain of 83 +/- 61 cal/min, whereas dialysate at 34 degrees C produced a loss of 463 +/- 121 cal/min. Monitoring extracorporeal thermal energy balance during cooled-dialysate hemodialysis will facilitate the use of feedback loops for dialysate temperature control in order to maximize hemodynamic stability while reducing discomfort. This methodology also may be helpful in assessing the metabolic effects of protein intake, high flux dialysis, membrane biocompatibility, and adequacy of dialysis in relation to thermal energy balance.