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

Sun Mi Cha; Hye Sook Min

doi:10.7469/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

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

DOI: https://doi.org/10.7469/KJAN.2017.29.6.604

¹Hemodialysis Unit, Bethesda Hospital, Yangsan, Korea

²Department of Nursing, Dong-A University, Busan, Korea

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

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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Abstract
REFERENCES

Abstract

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)
Gender	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)
Current drinking	No	23 (74.2)
Current smoking	Ｙ es	11 (35.5)
Current smoking	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)
Types of vascular access	AVG	8 (25.8)
Starting time of HD	Morning	19 (61.3)
Starting time of HD	Afternoon	12 (38.7)
Taken antihypertensives prior to HD	Yes	24 (77.4)
Taken antihypertensives prior to HD	No	7 (22.6)
Taken vasodilators prior to HD	Yes	4 (12.9)
Taken vasodilators prior to HD	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
Variables	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	F	p
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)
Variables	Frequency of occurrences (M± SD)			F	p (Bonferroni)
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
Variables	Number of Times	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	F	p
Abdominal discomfort∗	0	29 (93.6)	29 (93.6)	31 (100.0)
Abdominal discomfort∗	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)
Nausea∗	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)
Dizziness∗	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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4.Ramos R, Soto C, Mestres R, Jara J, Zequera H, Merello JI, et al. How can symptomatic hypotension be improved in hemodialysis patients: cold dialysis vs isothermal dialysis. Nefrologia.. 2007;27(6):737-41.
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6.K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. American Journal of Kidney Diseases.. 2005;45(4):S16-153. https://doi.org/10.1053/j.ajkd.2005.01.019.
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8.Kim HJ. Effects of application of elastic compression stockings on blood pressure, pulse rate and hypotension symptoms in patients with intradialytic hypotension [master's thesis]. Daegu: Catholic University; 2014;1-50.
9.Morfin JA, Fluck RJ, Weinhandl ED, Kansal S, McCullough PA, Komenda P. Intensive hemodialysis and treatment complications and tolerability. American Journal of Kidney Diseases.. 2016;68(5):S43-50. https://doi.org/10.1053/j.ajkd.2016.05.021.
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10.Kim JA, Yun JH, Jang IS, Lee MS, Hur YS, Shin JH, et al. The effect of gradient ultrafiltration and high sodium dialysate on reducing complications during hemodialysis. Kidney Research and Clinical Practice.. 2002;21(3):450-9.
11.Schneditz D, Levin NW. Keep your temper: how to avoid heat accumulation in haemodialysis. Nephrology, Dialysis, Transplantation.. 2001;16(1):7-9. https://doi.org/10.1093/ndt/16.1.7.
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12.Rosales LM, Schneditz D, Morris AT, Rahmati S, Levin NW. Isothermic hemodialysis and ultrafiltration. American Journal of Kidney Diseases.. 2000;36(2):353-61. https://doi.org/10.1053/ajkd.2000.8986.
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13.Pérgola PE, Habiba NM, Johnson JM. Body temperature regu-lation during hemodialysis in long-term patients: is it time to change dialysate temperature prescription? American Journal of Kidney Diseases.. 2004;44(1):155-65. https://doi.org/10.1053/j.ajkd.2004.03.036.
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14.Lee YJ, Han JJ, Ha SJ, Park MN, Moon JY, Jeong KH, et al. The effect of cool dialysate & sodium profiling on hemodynamics in patients with intradialytic hypotension. Kidney Research and Clinical Practice.. 2007;26(5):567-74.
15.Son MH. Effects of low temperature dalysis on the sleep con-ditions and dialytic stability of hemodialysis patients [master's thesis]. Daegu: Keimyung University; 2009;1-64.
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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

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

Table 1.

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

Characteristics	Categories	n (%) or M± SD
Gender	Male	21 (67.7)
Gender	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)
Current drinking	No	23 (74.2)
Current smoking	Ｙ es	11 (35.5)
Current smoking	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)
Types of vascular access	AVG	8 (25.8)
Starting time of HD	Morning	19 (61.3)
Starting time of HD	Afternoon	12 (38.7)
Taken antihypertensives prior to HD	Yes	24 (77.4)
Taken antihypertensives prior to HD	No	7 (22.6)
Taken vasodilators prior to HD	Yes	4 (12.9)
Taken vasodilators prior to HD	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
Variables	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	F	p
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)
Variables	Frequency of occurrences (M± SD)			F	p (Bonferroni)
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
Variables	Number of Times	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	F	p
Abdominal discomfort∗	0	29 (93.6)	29 (93.6)	31 (100.0)
Abdominal discomfort∗	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)
Nausea∗	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)
Dizziness∗	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.

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