Effect of Different Dialysate Temperatures on Beta-2-Microglobulin Reduction in Hemodialysis Patients
Year: 2024
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: 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±14.6mg/dL and 26.2±5.9mg/dL, and post-dialysis levels were 8.7±5.6 mg/dL and 7.2±2.6mg/dL.In sequence B, pre-dialysis B2M level of 37°C and 35°C dialysates were 27.1±3.6mg/dL and 24.9±7.6 mg/dL, post-dialysis levels were 6.4±2.7 mg/dL and 9.0±3.4mg/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±2.83mmHg, 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.
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: Khon Kaen University
OpenAlex ID: W4406338885