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Cool dialysate reduces asymptomatic intradialytic hypotension and increases baroreflex variability
Author(s) -
CHESTERTON Lindsay J.,
SELBY Nicholas M.,
BURTON James O.,
McINTYRE Chris W.
Publication year - 2009
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2009.00355.x
Subject(s) - medicine , asymptomatic , baroreflex , hemodialysis , cardiology , anesthesia , blood pressure , heart rate
Intradialytic hypotension (IDH) remains an important cause of morbidity and mortality in chronic hemodialysis (HD) patients and can be ameliorated by cool temperature HD. The baroreflex arc is under autonomic control and is essential in the short‐term regulation of blood pressure (BP). This study aimed to investigate if the baroreflex sensitivity (BRS) response to HD differed between standard and cool‐temperature dialysate. Ten patients (mean age 67±2 years) prone to IDH were recruited into a randomized, crossover study to compare BRS variation at dialysate temperatures of 37 °C (HD 37 ) and 35 °C (HD 35 ). Each patient underwent continuous beat‐to‐beat BP monitoring during a dialysis session of HD 37 and HD 35 . During HD 37 2 patients developed symptomatic IDH, as opposed to 1 with HD 35 . However, asymptomatic IDH occurred with a frequency of 0.4 episodes per session with HD 35 and 6.2 episodes per session during HD 37 (odds ratio15.5; 95%CI 5.6–14.2). Although absolute BRS measurements did not differ between the 2 modalities, BRS variability increased during HD 35 . Our study has demonstrated that in IDH‐prone patients, cool HD resulted in a reduction in heart rate and a greater reduction in cardiac output and stroke volume. Mean arterial pressure was maintained through a significantly greater increase in total peripheral resistance. Furthermore, although absolute BRS values during HD were not significantly altered by a reduction in dialysate temperature, there was a greater percentage increase in BRS values during cool HD. Understanding the varied causes of, and categorizing impaired hemodynamic responses to HD will enable further individualization of HD prescriptions according to patient need.