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Original Research

The Effect of Dialysate Temperature on Blood Pressure, Core Temperature, and Physical Symptoms in Hemodialysis Patients

Sun Mi Cha, MSN, RN1, Hye Sook Min, Ph.D., RN2
Korean Journal of Adult Nursing 2017;29(6):604-614.
Published online: December 18, 2017

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Corresponding author: Min, Hye Sook Department of Nursing, Dong-A University, Daesin Gongwon-ro, Seo-gu, Busan 49201 Korea. Tel: +82-51-240-2872, Fax: +82-51-240-2920, E-mail: hsmin@dau.ac.kr
This study was supported by the research fund from Dong-A University.
• Received: August 2, 2017   • Accepted: December 1, 2017

© 2017 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study utilized a randomized block-design for the purpose of studying the effect of dialysate temperature on blood pressure (BP), core temperature, and physical symptoms in hemodialysis patients. The sample was thirty-one patients undergoing hemodialysis assigned to one of three groups. were divided into 3 groups.
  • Methods
    Repeated analysis of variance to number of hypotension occurrences, core temperature changes, and physical symptoms at cool dialysis with dialysate of 35.5°C, standard dialysis with dialysate of 36.5°C and isothermic dialysis based on blood temperature feedback monitor (BTM). Each of the three groups underwent hemodialysis six times at a specific dialysate temperature.
  • Results
    The number of hypotension events were 21 at cool dialysis, 47 at standard dialysis, and 27 at isothermic dialysis, occurrences under cool dialysis were less frequent than under standard dialysis (F=8.08, p=.002). The patients’ core temperature increased by 0.07°C at cool dialysis, 0.21°C at standard dialysis, and 0.18°C at isothermic dialysis, cool dialysis showed a significantly smaller increase in core temperature (F=17.76, p<.001). There was no difference in the incidence of physical symptoms related to dialysate temper-atures (F=2.04, p=.146).
  • Conclusion
    Cool dialysis resulted in a significant prevention of the increase in core temperature and was more effective than standard dialysis in preventing hypotension. Isothermic dialysis had no pos-itive effects in preventing the increase in core temperature or occurrences of hypotension.
  • Key Words: Renal dialysis; Hemodialysis solutions; Temperature; Blood pressure; Body temperature
Table 1.
General Characteristics and Hemodialysis-related Characteristics of Participants (N=31)
Characteristics Categories n (%) or M± SD
Gender Male 21 (67.7)
Female 10 (32.3)
Age (year) ≤49 5 (16.1)
50~69 15 (48.4)
≥70 11 (35.5) 62.06±12.95
Marital status Married 26 (83.9)
Single 3 (9.6)
Divorced/bereaved 2 (6.5)
Current drinking Ｙ es 8 (25.8)
No 23 (74.2)
Current smoking Ｙ es 11 (35.5)
No 20 (64.5)
Diseases of cause Diabetes 15 (48.4)
Hypertension 8 (25.8)
CGN 4 (12.9)
Others 4 (12.9)
Time with HD (month)   51.16±56.57
Duration of each HD (minute) 233.40±16.81
Types of vascular access AVF 23 (74.2)
AVG 8 (25.8)
Starting time of HD Morning 19 (61.3)
Afternoon 12 (38.7)
Taken antihypertensives prior to HD Yes 24 (77.4)
No 7 (22.6)
Taken vasodilators prior to HD Yes 4 (12.9)
No 27 (87.1)
AVF=arteriovenous fistula; AVG=arteriovenous grafts;

CGN=chronic glomerulonephritis; HD=hemodialysis.

Table 2.
Homogeneity Tests of Three Groups of Dialysate Temperature (N=31)
Variables A (35.5℃) B (36.5℃) C (BTM) F p
n (%) or M± SD n (%) or M± SD n (%) or M± SD
SBP (mmHg) 138.82±11.93 140.86±11.69 140.91±10.29 1.31 .276
DBP (mmHg) 70.11±4.65 71.72±5.26 71.99±6.59 1.80 .174
Core temperature (℃) 36.34±0.15 36.32±0.13 36.29±0.11 1.90 .159
Body weight (kg) 61.37±11.21 61.47±11.35 61.63±11.35 2.66 .093
Ultrafiltration volume (L) 1.73±1.33 1.65±0.89 1.79±0.95 0.53 .505

A=cool dialysis; B=standard dialysis; C=isothermic dialysis; BTM=blood temperature feedback monitor; SBP=systolic blood pressure; DBP=diastolic blood pressure.

Table 3.
Comparison of Hypotension Occurrence and Core Temperature according to Dialysate Temperature (N=31)
Variables A (35.5℃) B (36.5℃) C (BTM) F p (Bonferroni)
Frequency of occurrences (M± SD)
Hypotension occurrence 21 (0.11±0.18) 47 (0.25±0.27) 27 (0.15±0.22) 8.08 .002(A＜ B)
Pre HD BT (℃) 36.34±0.15 36.32±0.13 36.29±0.11 1.90  
Post HD BT (℃) 36.40±0.14 36.52±0.13 36.47±0.15 12.68  
Differences (℃) 0.07±0.13 0.21±0.12 0.18±0.13 17.76 ＜.001(A＜ B, A＜ C)

A=cool Dialysis; B=standard dialysis; C=isothermic dialysis; BTM=Blood temperature feedback monitor; HD=hemodialysis; BT=blood core temperature.

Table 4.
Comparison of Physical Symptoms based on Dialysate Temperature (N=31)
Variables Number of Times A (35.5℃) B (36.5℃) C (BTM) F p
n (%) or M± SD n (%) or M± SD n (%) or M± SD
Abdominal discomfort∗ 0 29 (93.6) 29 (93.6) 31 (100.0)    
1 2 (6.4) 2 (6.4) 0 (0.0)    
Yawning∗ 0 31 (100.0) 30 (96.8) 31 (100.0)    
1 0 (0.0) 0 (0.0) 0 (0.0)    
2 0 (0.0) 0 (0.0) 0 (0.0)    
3 0 (0.0) 1 (3.2) 0 (0.0)    
Nausea∗ 0 31 (100.0) 30 (96.8) 31 (100.0)    
1 0 (0.0) 1 (3.2) 0 (0.0)    
Muscle cramp∗ 0 27 (87.1) 28 (90.3) 28 (90.3)    
1 3 (9.7) 2 (6.5) 3 (9.7)    
2 1 (3.2) 0 (0.0) 0 (0.0)    
3 0 (0.0) 1 (3.2) 0 (0.0)    
Dizziness∗ 0 31 (100.0) 29 (93.6) 29 (93.6)    
1 0 (0.0) 2 (6.4) 2 (6.4)    
Sweating∗ 0 28 (90.3) 29 (93.6) 30 (96.8)    
1 3 (9.7) 0 (0.0) 1 (3.2)    
2 0 (0.0) 1 (3.2) 0 (0.0)    
3 0 (0.0) 1 (3.2) 0 (0.0)    
Chills∗ 0 0 (0.0) 0 (0.0) 0 (0.0)    
Cold∗ 0 0 (0.0) 0 (0.0) 0 (0.0)    
Occurrence of physical symptoms 0.05±0.10 0.10±0.17 0.04±0.07 2.04 .146

A=cool dialysis; B=standard dialysis; C=isothermic dialysis; BTM=blood temperature feedback monitor; ∗Multiple response.

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      The Effect of Dialysate Temperature on Blood Pressure, Core Temperature, and Physical Symptoms in Hemodialysis Patients
      Korean J Adult Nurs. 2017;29(6):604-614.   Published online December 31, 2017
      DOI: https://doi.org/10.7475/kjan.2017.29.6.604
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      The Effect of Dialysate Temperature on Blood Pressure, Core Temperature, and Physical Symptoms in Hemodialysis Patients
      Korean J Adult Nurs. 2017;29(6):604-614.   Published online December 31, 2017
      DOI: https://doi.org/10.7475/kjan.2017.29.6.604
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      The Effect of Dialysate Temperature on Blood Pressure, Core Temperature, and Physical Symptoms in Hemodialysis Patients
      The Effect of Dialysate Temperature on Blood Pressure, Core Temperature, and Physical Symptoms in Hemodialysis Patients

      General Characteristics and Hemodialysis-related Characteristics of Participants (N=31)

      Characteristics Categories n (%) or M± SD
      Gender Male 21 (67.7)
      Female 10 (32.3)
      Age (year) ≤49 5 (16.1)
      50~69 15 (48.4)
      ≥70 11 (35.5) 62.06±12.95
      Marital status Married 26 (83.9)
      Single 3 (9.6)
      Divorced/bereaved 2 (6.5)
      Current drinking Ｙ es 8 (25.8)
      No 23 (74.2)
      Current smoking Ｙ es 11 (35.5)
      No 20 (64.5)
      Diseases of cause Diabetes 15 (48.4)
      Hypertension 8 (25.8)
      CGN 4 (12.9)
      Others 4 (12.9)
      Time with HD (month)   51.16±56.57
      Duration of each HD (minute) 233.40±16.81
      Types of vascular access AVF 23 (74.2)
      AVG 8 (25.8)
      Starting time of HD Morning 19 (61.3)
      Afternoon 12 (38.7)
      Taken antihypertensives prior to HD Yes 24 (77.4)
      No 7 (22.6)
      Taken vasodilators prior to HD Yes 4 (12.9)
      No 27 (87.1)
      AVF=arteriovenous fistula; AVG=arteriovenous grafts;

      CGN=chronic glomerulonephritis; HD=hemodialysis.

      Homogeneity Tests of Three Groups of Dialysate Temperature (N=31)

      Variables A (35.5℃) B (36.5℃) C (BTM) F p
      n (%) or M± SD n (%) or M± SD n (%) or M± SD
      SBP (mmHg) 138.82±11.93 140.86±11.69 140.91±10.29 1.31 .276
      DBP (mmHg) 70.11±4.65 71.72±5.26 71.99±6.59 1.80 .174
      Core temperature (℃) 36.34±0.15 36.32±0.13 36.29±0.11 1.90 .159
      Body weight (kg) 61.37±11.21 61.47±11.35 61.63±11.35 2.66 .093
      Ultrafiltration volume (L) 1.73±1.33 1.65±0.89 1.79±0.95 0.53 .505

      A=cool dialysis; B=standard dialysis; C=isothermic dialysis; BTM=blood temperature feedback monitor; SBP=systolic blood pressure; DBP=diastolic blood pressure.

      Comparison of Hypotension Occurrence and Core Temperature according to Dialysate Temperature (N=31)

      Variables A (35.5℃) B (36.5℃) C (BTM) F p (Bonferroni)
      Frequency of occurrences (M± SD)
      Hypotension occurrence 21 (0.11±0.18) 47 (0.25±0.27) 27 (0.15±0.22) 8.08 .002(A＜ B)
      Pre HD BT (℃) 36.34±0.15 36.32±0.13 36.29±0.11 1.90  
      Post HD BT (℃) 36.40±0.14 36.52±0.13 36.47±0.15 12.68  
      Differences (℃) 0.07±0.13 0.21±0.12 0.18±0.13 17.76 ＜.001(A＜ B, A＜ C)

      A=cool Dialysis; B=standard dialysis; C=isothermic dialysis; BTM=Blood temperature feedback monitor; HD=hemodialysis; BT=blood core temperature.

      Comparison of Physical Symptoms based on Dialysate Temperature (N=31)

      Variables Number of Times A (35.5℃) B (36.5℃) C (BTM) F p
      n (%) or M± SD n (%) or M± SD n (%) or M± SD
      Abdominal discomfort∗ 0 29 (93.6) 29 (93.6) 31 (100.0)    
      1 2 (6.4) 2 (6.4) 0 (0.0)    
      Yawning∗ 0 31 (100.0) 30 (96.8) 31 (100.0)    
      1 0 (0.0) 0 (0.0) 0 (0.0)    
      2 0 (0.0) 0 (0.0) 0 (0.0)    
      3 0 (0.0) 1 (3.2) 0 (0.0)    
      Nausea∗ 0 31 (100.0) 30 (96.8) 31 (100.0)    
      1 0 (0.0) 1 (3.2) 0 (0.0)    
      Muscle cramp∗ 0 27 (87.1) 28 (90.3) 28 (90.3)    
      1 3 (9.7) 2 (6.5) 3 (9.7)    
      2 1 (3.2) 0 (0.0) 0 (0.0)    
      3 0 (0.0) 1 (3.2) 0 (0.0)    
      Dizziness∗ 0 31 (100.0) 29 (93.6) 29 (93.6)    
      1 0 (0.0) 2 (6.4) 2 (6.4)    
      Sweating∗ 0 28 (90.3) 29 (93.6) 30 (96.8)    
      1 3 (9.7) 0 (0.0) 1 (3.2)    
      2 0 (0.0) 1 (3.2) 0 (0.0)    
      3 0 (0.0) 1 (3.2) 0 (0.0)    
      Chills∗ 0 0 (0.0) 0 (0.0) 0 (0.0)    
      Cold∗ 0 0 (0.0) 0 (0.0) 0 (0.0)    
      Occurrence of physical symptoms 0.05±0.10 0.10±0.17 0.04±0.07 2.04 .146

      A=cool dialysis; B=standard dialysis; C=isothermic dialysis; BTM=blood temperature feedback monitor; ∗Multiple response.
      Table 1. General Characteristics and Hemodialysis-related Characteristics of Participants (N=31)

      CGN=chronic glomerulonephritis; HD=hemodialysis.

      Table 2. Homogeneity Tests of Three Groups of Dialysate Temperature (N=31)

      A=cool dialysis; B=standard dialysis; C=isothermic dialysis; BTM=blood temperature feedback monitor; SBP=systolic blood pressure; DBP=diastolic blood pressure.

      Table 3. Comparison of Hypotension Occurrence and Core Temperature according to Dialysate Temperature (N=31)

      A=cool Dialysis; B=standard dialysis; C=isothermic dialysis; BTM=Blood temperature feedback monitor; HD=hemodialysis; BT=blood core temperature.

      Table 4. Comparison of Physical Symptoms based on Dialysate Temperature (N=31)

      A=cool dialysis; B=standard dialysis; C=isothermic dialysis; BTM=blood temperature feedback monitor; ∗Multiple response.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

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