• Summary: More than 2 million people worldwide with kidney failure rely on maintenance HD treatments 3 times a week to sustain life. The median life expectancy for these patients is 3–4 years, and cardiovascular disease is the leading cause of morbidity and mortality. Maintenance HD is typically done by use of a standard dialysate temperature of 36·5°C or 37·0°C for all pts. The historical reason for this choice is not clear but could represent what is considered the average body temperature of most adults. Previous studies have shown that the rate of intradialytic hypotension was reduced by 70% (95% CI 49–89) with cooler dialysate versus standard temperature dialysate (pooled effect from 11 trials). trials); the drop in pre-dialysis minus nadir intradialytic systolic blood pressure was lessened by about 10 mm Hg with cooler dialysate (two trials), and the drop in pre-dialysis minus post-dialysis mean arterial blood pressure was lessened by 12 mm Hg with cooler dialysate (95% CI 8–16 mm Hg; pooled effect from 12 trials). No trial assessed outcomes of mortality, hospital admission, or major adverse cardiovascular events have ever been done..

Objectives:

At the conclusion of this activity, the learner should be able to:

• Define pragmatic trial
• Recognize the role of reduced temp on HD
• Assess cardiovascular outcome on long term dialysis temperature

Bio:

Michael Bernaba is a nephrology fellow at Mayo Clinic Arizona. He enjoys long walks on the beach.

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TRANSCRIPT
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