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Several studies have highlighted the hemodynamic advantages of hypothermic dialysate, which induce regional differences in blood flow and potentially impact dialytic efficiency. While urea clearance has been extensively studied, its intercompartmental behavior raises questions about its suitability as a sole indicator for assessing the impact of hypothermic dialysate on the clearance of other uremic toxins. This study aimed to compare the influence of intradialytic exercise (IDE) on the clearance of uremic toxins using isotonic and hypothermic dialysate in post-dilution hemodiafiltration (HDF) patients.
Twenty-eight HDF patients underwent four sessions, including two with hypothermic dialysate (1°C below body temperature) with and without IDE, and two with isotonic dialysate with and without IDE. Serial measurements of uremic toxins, including urea nitrogen (UN), creatinine (Cr), uric acid (UA), potassium (K), and phosphorus (P), were collected in serum and dialysate to assess their clearance.
This study revealed a decrease in phosphorus clearance with hypothermic dialysate, attributed to the multi-compartmental kinetics of phosphorus during hemodialysis. Conversely, the implementation of intradialytic exercise mitigated this decrease, leading to improved phosphorus clearance in the presence of hypothermia while preserving the hemodynamic benefits associated with this treatment.