Body temperature regulation during hemodialysis in long-term patients: is it time to change dialysate temperature prescription?
During hemodialysis procedures, changes in the dialysate temperature can raise or lower body temperature because the blood is returned to the patient in thermal equilibrium with the dialysate. Even a dialysate temperature equal to the patient's body temperature as measured from the tympanic mem...
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Published in | American journal of kidney diseases Vol. 44; no. 1; p. 155 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
United States
01.07.2004
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Abstract | During hemodialysis procedures, changes in the dialysate temperature can raise or lower body temperature because the blood is returned to the patient in thermal equilibrium with the dialysate. Even a dialysate temperature equal to the patient's body temperature as measured from the tympanic membrane, oral cavity, or axilla can result in an increase in the patient's body temperature, leading to cutaneous vasodilation and the potential for cardiovascular instability and hypotension. This deleterious cycle of events can be prevented by suitably adjusting the dialysate temperature. Lowering the dialysate temperature from 37 degrees C to 34-35.5 degrees C has improved the cardiovascular stability of many hemodialysis patients. Continuous monitoring of blood temperature allows the practitioner to make preemptive changes in dialysate temperature because a small change in body temperature can have enormous cardiovascular implications. For example, only 0.3 degrees C to 0.8 degrees C separates the thresholds for skin vasodilation from that for shivering. A suggested improvement in the hemodialysis procedure is to use devices that allow continuous monitoring of arterial and venous blood temperatures and adjust the dialysate temperature automatically, keeping the patient, not the dialysate, isothermic. Less optimal solutions appear to be (1) to monitor arterial and venous temperatures while manually adjusting the dialysate temperature to maintain arterial (and hence body) temperature stability; (2) to monitor peripheral temperatures (oral, tympanic) at regular intervals and adjust dialysate temperature to maintain the body temperature constant; (3) routinely use a dialysate temperature <37.0 degrees C in all patients unless contraindicated. |
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AbstractList | During hemodialysis procedures, changes in the dialysate temperature can raise or lower body temperature because the blood is returned to the patient in thermal equilibrium with the dialysate. Even a dialysate temperature equal to the patient's body temperature as measured from the tympanic membrane, oral cavity, or axilla can result in an increase in the patient's body temperature, leading to cutaneous vasodilation and the potential for cardiovascular instability and hypotension. This deleterious cycle of events can be prevented by suitably adjusting the dialysate temperature. Lowering the dialysate temperature from 37 degrees C to 34-35.5 degrees C has improved the cardiovascular stability of many hemodialysis patients. Continuous monitoring of blood temperature allows the practitioner to make preemptive changes in dialysate temperature because a small change in body temperature can have enormous cardiovascular implications. For example, only 0.3 degrees C to 0.8 degrees C separates the thresholds for skin vasodilation from that for shivering. A suggested improvement in the hemodialysis procedure is to use devices that allow continuous monitoring of arterial and venous blood temperatures and adjust the dialysate temperature automatically, keeping the patient, not the dialysate, isothermic. Less optimal solutions appear to be (1) to monitor arterial and venous temperatures while manually adjusting the dialysate temperature to maintain arterial (and hence body) temperature stability; (2) to monitor peripheral temperatures (oral, tympanic) at regular intervals and adjust dialysate temperature to maintain the body temperature constant; (3) routinely use a dialysate temperature <37.0 degrees C in all patients unless contraindicated. |
Author | Pérgola, Pablo E Habiba, Nusrath M Johnson, John M |
Author_xml | – sequence: 1 givenname: Pablo E surname: Pérgola fullname: Pérgola, Pablo E email: Pergola@UTHSCSA.edu organization: Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA. Pergola@UTHSCSA.edu – sequence: 2 givenname: Nusrath M surname: Habiba fullname: Habiba, Nusrath M – sequence: 3 givenname: John M surname: Johnson fullname: Johnson, John M |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/15211448$$D View this record in MEDLINE/PubMed |
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SubjectTerms | Adult Body Temperature - physiology Body Temperature Regulation - physiology Circadian Rhythm - physiology Dialysis Solutions - administration & dosage Dialysis Solutions - chemistry Equipment Design Humans Monitoring, Physiologic - instrumentation Monitoring, Physiologic - methods Reference Values Renal Dialysis - methods Thermography - methods Thermography - standards Thermometers - classification Thermometers - standards |
Title | Body temperature regulation during hemodialysis in long-term patients: is it time to change dialysate temperature prescription? |
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