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Thermal balance and dialysis hypotension
Q Maggiore1, P Dattolo, M Piacenti
1Dialysis and Nephrology Unit, CNR Clinical Physiology Institute, Ospedale S.M. Annunziata, Firenze, Italy.
The International Journal of Artificial Organs
|September 1, 1995
Summary
Using cooler dialysate fluid (35°C) during dialysis offers better hemodynamic protection than standard temperatures (37-38°C). Cold dialysis improves blood pressure stability by enhancing venous return and total peripheral vascular resistance.
Area of Science:
- Nephrology
- Cardiovascular Physiology
Background:
- Dialysis often causes blood pressure drops (hypotension).
- Standard dialysate temperature is 37-38°C.
- Cooler dialysate (35°C) may offer hemodynamic protection.
Purpose of the Study:
- To investigate the hemodynamic mechanisms behind the protective effect of cold dialysis on blood pressure.
- To compare hemodynamic changes during standard versus cold dialysis in patients experiencing intradialysis hypotension.
Main Methods:
- Serial assessment of stroke volume, blood volume, arterial pressure, and heart rate.
- Calculation of cardiac output (CO) and total peripheral vascular resistance (TPVR).
- Comparison of hemodynamic parameters in patients with stable versus unstable intradialysis mean arterial pressure (MAP), and during crossover to cold dialysis.
Main Results:
- Unstable patients showed a significant drop in MAP, disproportionate reduction in CO, and decreased TPVR during standard dialysis.
- Cold dialysis (35°C) resulted in a significantly lower reduction in MAP.
- Unstable patients on cold dialysis exhibited a smaller decrease in CO, paralleling blood volume changes, and an increase in TPVR.
Conclusions:
- Dialysis hypotension is linked to impaired venous return and decreased TPVR.
- Cold dialysate enhances venous return by increasing TPVR and stressed blood volume.
- Cooler dialysate (35°C) is a promising strategy to prevent intradialysis hypotension.