Cooler dialysate does not offer any clinical benefits

The adoption of cooler dialysate as a centre-wide policy is not justified as it has a shown a lack of cardiovascular (CV) benefits and was compounded by the likelihood of patient discomfort. However, for nephrologists who are already using it in individualised patient care, the results of the MyTemp study offer an opportunity to reflect on practice, and perhaps, alter it [1].

“For each haemodialysis treatment, the temperature of dialysate on the machine is set at 36.5°C or 37.0°C for all patients and all treatments,” Prof. Amit Garg (London Health Sciences Centre and Western University, Ontario, Canada) said. “A recent survey amongst >270 centres revealed that over half now use cooler dialysate (e.g. 36.0°C or lower) to gain potential CV benefits.” Garg et al. aimed to assess whether adopting a centre-wide protocol of personalised cooler dialysate is superior to standard temperature dialysate in reducing the risk of CV-related death or CV hospital admission and lessening a drop in systolic blood pressure, and whether it is well accepted by patients.

The MyTEMP trial (NCT02628366) was a pragmatic, cluster-randomised study conducted from 2017 to 2021 in 84 of Ontario’s 97 haemodialysis centres. Participating centres were randomised to a group in which the temperature of the dialysis fluid was set at 0.5°C below each patient’s body temperature as measured prior to starting dialysis (personalised cooler dialysate) and to a group in which the temperature was set to 36.5°C for all patients and all treatments (standard temperature dialysate). This study is the largest trial of maintenance haemodialysis published to date and includes over 95% of patients receiving haemodialysis in Ontario during the trial period (>15,000 patients and >4.3 million dialysis treatments). Mean temperature was 36.4°C in the standard group 35.8°C in the cooler group. Prof. Garg showed that adopting a centre-wide policy of personalised cooler dialysate versus a standard temperature dialysate did not reduce the risk of major adverse cardiovascular events or death. “The primary outcome occurred in 21.4% of patients in the cooler dialysate group versus 22.4% of patients in the standard temperature group (adjusted HR 1.00; 96% CI 0.89–1.11; 2-sided P=0.93).” Mean drop in intradialytic systolic blood pressure was 26.6 mmHg in the cooler dialysate group and 27.1 mmHg in the standard temperature group (mean difference −0.5 mmHg; 99% CI −1.4 to 0.4; P=0.14), which was not statistically significant. “Patients in the personalised cooler dialysate group were more likely to feel cold on dialysis than respondents in the standard-temperature group,” Prof. Garg added. It was concluded that the intervention lacked measurable benefit, which was compounded by the likelihood of patient discomfort, indicating that cooler dialysate should not be adopted as a centre-wide policy.

1. Garg AX, et al. Personalized Cooler Dialysate for Patients Receiving Maintenance Hemodialysis. FR-OR66, ASN Kidney Week 2022, 3–6 Nov.

 

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Posted on 8 December, 2022