Effect of Dialysate Temperature and Patient Hematocrit on the Diffusive Permeability during Hemodialysis in Prevalent Hemodialysis Patients

Abstract Introduction Although hemodynamic stability with lower dialysate temperature is well established, it is still not known if there is a compromise in uremic clearance with cool dialysate therapy. Objectives Assessment of the effect of dialysate temperature and patient hematocrit on solute diffusion in hemodialysis patients. Methods Cross section of 50 adult clinically stable ESRD patients on thrice weekly hemodialysis sessions were recruited. Patients were divided into two groups according to their hematocrit (Hct) value into group (A): 25 patients with Hct below or equal to 30% and group (B): 25 patients with Hct above 30%. Each patient in both groups received two HD sessions with different dialysate temperature setting, one with 36° C and the other with temperature set on 37 °C. Laboratory investigations as serum, urea, creatinine, CBC, Kt/V and virology were done at the start of the study sessions and at the end of the same sessions. Results Patients were age and sex similar, with HTN being most common cause of ESKD in both groups. No significant change in URR, Kt\V or ultrafilteration volume between both groups at either dialysate temp. SBP showed higher value in patients with higher Hct with a trend of significance (p-value 0.09) with dialysate of 37ºc. Patients in both groups showed significant increase in intra-dialytic change in creatinine at dialysate temperature of 36ºc compared to 37ºc. Conclusions Our study suggests that lowering the dialysate temperature from 37 °C to 36 °C for patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (HD) does not significantly impact dialysis adequacy parameters (URR and KT/V) or blood pressure, unlike intradialytic creatinine change with cool dialysate sessions, which showed a significant increase. Moreover, hematocrit changes were not associated with significant difference in HD adequacy parameters.