Effect of Different Dialysate Temperatures on Beta-2-Microglobulin Reduction in Hemodialysis Patients
Jarubut Phisutrattanaporn1*, Sawinee Kongpetch2*, Renoo Tachaiya2,3, Suriyaporn Jansorn2,3, Pongsai Wiangnon2,3, Piyanat Pongsutat2,3, Sirirat Anutrakulchai2,4 1
Affiliation : 1Department of Medicine, Sukhothai Hospital, Sukhothai, Thailand 2 Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand 3 Hemodialysis Unit of Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand 4 Division of Nephrology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
* Jarubut Phisutrattanaporn and Sawinee Kongpetch are equal contributors to this paper and designated as co-first authors
Background: Higher body temperature can induce systemic vasodilation and decrease inter-compartmental resistance, a major barrier of middlemolecule toxin clearance in hemodialysis (HD).
Objective: To determine the effect of high dialysate temperature which increases body temperature on Beta-2-Microglobulin (B2M) reduction.
Materials and Methods: A cross over randomized control trial was conducted in stable HD patients between October and December 2017. Subjects were randomized into 2 sequences: (A) dialysis with 35°C then 37°C dialysate, and (B) dialysis with 37°C then 35°C dialysate. Each dialysis period lasted for 2 weeks and was washed out by dialysis with 36°C dialysate. Primary outcome was mean difference of B2M percent reduction ratio (%RR) determined by using pair t-test.
Results: Total 27 HD patients with mean age of 65.9±8.8 years and blood pressure (BP) 158/66 mmHg were enrolled. In sequence A, pre-dialysis B2M levels of 35°C and 37°C dialysates were 27.7±14.6 mg/dL and 26.2±5.9 mg/dL, and post-dialysis levels were 8.7±5.6 mg/dL and 7.2±2.6 mg/dL. In sequence B, pre-dialysis B2M level of 37°C and 35°C dialysates were 27.1±3.6 mg/dL and 24.9±7.6 mg/dL, post-dialysis levels were 6.4±2.7 mg/dL and 9.0±3.4 mg/dL. Overall treatment effect on B2M %RR was higher in the 37°C dialysate (mean difference -9.7±10.3%, 95% confidence interval -15.9 to -3.5, p=0.03). No significant difference in %RRs of blood urea nitrogen, creatinine, and electrolytes among the two temperatures. The difference of mean arterial BP was lower in the 37°C dialysate group (-4.3±2.83 mmHg, p<0.01). No major adverse events were noted in either group.
Conclusion: Raising of dialysate temperature to 37°C increased B2M reduction and slightly decrease in mean arterial BP compared with 35°C dialysate. Therefore, warm dialysate may be considered for enhanced reduction of B2M in stable HD patients with moderately high BP. However, long-term clinical outcomes with using 37°C dialysate need to be confirmed.
Received 9 April 2024 | Revised 10 July 2024 | Accepted 2 August 2024
DOI: 10.35755/jmedassocthai.2024.S01.S118-S125
Keywords : Hemodialysis; Dialysate temperature; Inter-compartmental resistance; Beta-2-Microglobulin (B2M) clearance; Reduction ratio
All Articles
Download