[Effects of cool dialysate temperature on stabilizing hemodynamic parameters in diabetic patients undergoing hemodialysis]

ABSTRACT

Hypotension is the most common acute complication of hemodialysis. To ameliorate symptomatic hypotiension during dialysis, cool temperature dialysate has been recommended. Since reports show that not all patients benefit from cool dialysis, it seems necessary to determine which patients benefit more from cool dialysis. The aim of this study is to investigate the effect of cool dialysis on hemodynamic parameters in diabetic patients; serum nitric oxide levels also were determined to find any possible association. Twenty diabetic patients [mean age 63.3 +/- 7.5] were included in the study. Each patient was dialyzed twice, once using cool and once using warm dialysate solution. Apart from a change in temperature to 35°C, all other conditions remained the same during the study. Hemodynamic parameters including SBP, DBP, and HR were measured hourly, the number of hypotension episodes was also determined. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites [NOx] were determined before and after hemodialysis. SBP, DBP, and MAP decreased significantly during warm, as compared to cool, dialysis. Maximum decreases in SBP, DBP, and MAP were seen in the third hour of dialysis and these were 18, 17, and 14 percent for warm and 6, 1, and 4 percent for cool dialysis respectively. HR showed no significant difference between the two groups. Compared to before dialysis, NOx levels decreased significantly in cool and warm conditions after dialysis [59 +/- 5 vs. 37 +/- 4, and 63 +/- 7 vs. 41 +/- 5, respectively, P<0.01]. Cool dialysis could decrease episodes of hypotension and stabilize hemodynamic parameters in diabetic patients. Mechanisms other than increased serum nitric oxide levels are involved in hemodialysis hypotension in diabetic patients