TEMPERATURE REGULATION TO COUNTER INFLAMMATION IN HEMODIALYSIS (TRIAD) STUDY

Introduction:

CKD is a chronic inflammatory state. This inflammatory state is accentuated by the activation of complement during dialysis. Inflammatory markers are associated with increased mortality and morbidity. Altering dialysate composition has been an active area of research in pursuit of making it more compatible, less inflammatory and more physiological. Lowering temperature of dialysate is well known to stabilize hemodynamics through induction of vasoconstriction. Many studies have shown that low temperature dialysate is well tolerated and lowers the risk of intradialytic hypotension. We studied the effect of a cooler dialysate on inflammatory markers (TNF-alpha, Interleukin-6) in patients undergoing maintenance hemodialysis.

Methods:

Study Population: 26 patients of CKD stage G5D on maintenance hemodialysis for at least 3 months were enrolled. This is a parallel group randomised case-control study with 1:1 allotment.
Duration: 8 months
Two groups - one with standard temperature dialysate (36.5 Celsius) and the other with Cold temperature dialysate (1 degree Celsius lesser than the core temperature, but never below 35 degree Celsius) were compared. The core temperature of the body is measured with an intra-aural thermometer (Braun series 7 Thermoscan) at every visit. The serum levels of TNF-alpha, Interleukin-6 were measured at baseline and after 8 months to study the effect of cold dialysate on these inflammatory markers. The inclusion and exclusion criteria are shown in table 1.

Results:

The baseline characteristics of the population with respect to age, sex, dialysis vintage, hypertension, diabetes and inter-dialytic weight gain were similar at baseline. There was a statistically significant difference in IL-6 between cases and controls at baseline(p<0.05). In both the groups, there was statistically insignificant change in IL-6 from baseline time to 8 months (p>0.05).There was statistically insignificant difference in TNF- ά between cases and controls at baseline(p>0.05). In both the groups, there was statistically insignificant change in TNF- ά from baseline time to 8 months (p>0.05).The incidence of interdialytic hypotension was significantly lower with cooler dialysate  (p=0.041).There were no statistically significant differences between the groups at baseline and at 8 months with respect to hemoglobin, erythropietin use, Kt/V and weight gain and mean ultrafiltration achieved. The use of cooler dialysate was well tolerated and did not cause any significant adverse effects.

Conclusions:

The use of cooler dialysate was well tolerated by patients on maintenance hemodialysis. Intradialytic hypotension was significantly less common with the use of cooler dialysate compared to standard temperature dialysate. The use of cooler dialysate did not have any effect on inflammatory markers (TNF-alpha, Il-6) in our study.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.