Does low-temperature dialysis still represent an advantage?: a narrative review from the last decade

Low-temperature hemodialysis (cool dialysis) is a therapeutic strategy aimed at preventing intradialytic hypotension and improving hemodynamic stability in patients with end-stage kidney disease (ESKD). Over the past decade, several studies have investigated its potential impact on cardiovascular outcomes, neurological protection, and clinical tolerability, with sometimes conflicting results.

An overview of the literature was conducted using PubMed® from January 1, 2015 to July 31, 2025, with the search terms cooler dialysis, cooler dialysate, and cooler dialysate and hemodynamic stability. Randomized and prospective clinical studies assessing the effects of low-temperature hemodialysis on hemodynamic, cardiac, and neurological outcomes were included.

Nine studies met the inclusion criteria. Small-scale trials reported a significant reduction in intradialytic hypotension episodes and a protective effect on left ventricular function. The large multicenter MyTEMP trial, while showing no significant reduction in major cardiovascular events, confirmed a trend toward improved blood pressure stability, at the expense of increased thermal discomfort. A Bayesian reanalysis of MyTEMP data suggested a high probability of clinical benefit. Effects on cerebral microcirculation and cognitive function remain uncertain.

Low-temperature hemodialysis is associated with improved hemodynamic stability and potential myocardial protection in specific patient subgroups; however, consistent effects on major cardiovascular events or cognitive decline in the general population have not been observed. Large, multicenter studies with extended follow-up are needed to better define clinical indications, long-term outcomes, and the identification of "responder" patients.