Chronic kidney disease patients undergoing dialysis are at an increased risk of developing adverse cardiovascular events such as heart attack, stroke, heart failure, and even death.
A clinical trial has evaluated the effectiveness of using a cooler dialysis fluid in reducing the risk of cardiovascular harm in patients undergoing maintenance dialysis.
Haemodialysis is a life-sustaining treatment for people with end-stage kidney disease. During this treatment, the blood of the patient is filtered through a machine that removes waste products and excess fluids. However, the treatment can cause side effects such as low blood pressure and cramps.
Dialysate, also called dialysis fluid, is a solution of pure water, electrolytes, and salts, such as bicarbonate and sodium. The purpose of dialysate is to pull toxins from the blood into the dialysate. The way this works is through a process called diffusion. Traditionally, the temperature of the dialysate is set at 36·5°C however, new evidence has suggested that the use of a lower temperature might be beneficial for the cardiovascular health of kidney disease patients.
To understand this further, researchers have conducted a clinical trial, called MyTEMP, which has looked into the use of personalized cooler dialysate for patients receiving maintenance hemodialysis.
The clinical study involved 15,413 patients undergoing maintenance dialysis across 84 centers. These patients were divided into two groups. One group received standard temperature dialysate while the other group received a personalized cooler dialysate. The personalized cooler dialysate was designed to be a few degrees cooler than the patient's body temperature. These patients were followed for 4 years to look for the development of adverse cardiovascular events such as heart attack, heart failure, stroke, and death.
The results of the clinical trial showed that adverse cardiovascular events occurred in 21.4% of the patients receiving cooler temperature dialysate. On the other hand, 22.4% of the patients receiving standard temperature dialysate developed adverse cardiovascular outcomes. Additionally, the average drop in systolic blood pressure during dialysis was 26·6 mm Hg in the cooler dialysate group and 27·1 mm Hg in the standard temperature group
These results indicate that patients who received the personalized cooler dialysate had a similar risk of experiencing cardiovascular side effects compared to the patients who received standard temperature dialysis fluid.
The results of the MyTEMP clinical trial are significant because they provide evidence that personalized cooler dialysate does not improve cardiovascular outcomes in patients undergoing hemodialysis.
In conclusion, the MyTEMP clinical study does not provide any evidence that personalized cooler dialysate can reduce the risk of side effects in patients undergoing hemodialysis. This is an important finding that could have a significant impact on the lives of patients with end-stage kidney disease. It is always important to discuss your treatment plan with your doctor to determine the best course of action for you.
The Lancet Journal, Nov-04-22