5°C with the majority of studies using 35°C or 35.5°C. In the BTM group patients underwent programmed cooling or isothermic dialysis, the temperature in the intervention group that underwent programmed cooling varied between 35.3°C and 35.7°C. The stability of the patients during HD also varied with Navitoclax a mixture of stable and unstable patients studied. A total of eight studies addressed the issue of IDH and cool temperature dialysis either using a fixed temperature reduction (6) or BTM (2).45,53–57
The overall rate of IDH was 7.1 times greater than in conventional dialysis (95% CI, 6.7–12.4) compared with thermo-regulated HD. In studies examining fixed temperature reduction the rate of IDH was 9.5 times less compared with the control while for those studies comparing isothermic cooling or programmed cooling the rate was 2 times less. When the data were adjusted for studies that had no IDH in the intervention group,45,56 the overall rate of IDH in cool dialysis was 2.6 times less compared with conventional dialysis (95% CI, 1.5–3.8). There was also a benefit on blood pressure post dialysis, with the higher values observed in cool dialysis, attributed to increased total peripheral
resistance. There were no differences in symptoms as reported click here by the patients. The issue of the optimal magnitude of temperature decrease was addressed in a recent trial (not included in the systematic review).58 Fourteen patients with a history of IDH were studied in a cross-over randomized trial. Isothermic dialysis was compared with ‘cooling’ dialysis (decrease core temperature by 0.5°C), with thermoneutral dialysis used as the control. The nadir of systolic blood pressure (SBP) during isothermic and thermoneutral dialysis was lower than during ‘cooling dialysis’ suggesting that greater stability is conferred by a small decrease in core body temperature. Temperature control can improve blood pressure stability in a IDH-prone population without causing discomfort or morbidity. The procedure is simple, safe and efficient to use. The check early concerns regarding dialysis quality
have not materialized; however, long-term prospective validation is lacking. The precise temperature at which the benefit is derived needs to be balanced with symptoms of hypothermia. It is also likely that individual patients have a different temperature threshold at which a benefit to haemodynamic stability is conferred. More studies using the BTM devices are needed to further establish its role, especially in the adjustment of core body temperature based on the individual patient susceptibility to IDH. This would ideally occur in the form a randomized trial comparing fixed temperature reduction, isothermic dialysis and dialysis with a small decrease in core body temperature. Future studies of temperature controlled dialysis need to show a reduction in morbidity and mortality as well as a cost benefit in reducing hospitalization rates.
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