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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Chronic inflammation represents a central determinant of cardiovascular morbidity and mortality in HD patients, driven by uremic toxins, comorbidities, and dialysis-related factors. Biological markers such as IL-6 and CRP are widely recognized indicators of this persistent inflammatory state. Cooled dialysate—delivered at temperatures below the standard 37°C—has been shown to enhance hemodynamic stability and reduce the incidence of intradialytic hypotension (IDH). Beyond its cardiovascular benefits, this approach has been hypothesized to modulate systemic inflammation, potentially enhancing dialysis tolerance and adequacy.
This crossover study included 50 ESRD patients on maintenance HD at Shebin Elkom Teaching Hospital. Each patient underwent three dialysis sessions utilizing cooled dialysate (35.5 °C), followed by three sessions employing standard dialysate (37 °C), separated by a one-week washout period. Blood samples were collected both before and after dialysis to evaluate adequacy (Kt/V and URR). Inflammatory indicators (CRP, IL-6, ESR) were measured at baseline and after each phase using ELISA kits for CRP and IL-6 and the Westergren method for ESR. Ethical approval and informed consent were obtained.
Serum CRP, IL-6, and ESR levels showed a significant reduction following cooled dialysate sessions compared to both baseline and warmed sessions (p < 0.001), whereas no significant differences were recorded among baseline and warmed sessions. In contrast, dialysis adequacy, assessed by URR and Kt/V, did not differ significantly among cooled and warmed phases. Furthermore, Serum albumin showed a strong negative correlation with CRP (rs = –0.589, p < 0.001 at baseline). Correlation analysis demonstrated a positive association between CRP and dialysis vintage (rs = 0.451, p = 0.001 at baseline). Both CRP and IL-6 were lowest among patients with A-V fistulas, indicating a lower inflammatory burden compared with patients using catheters or grafts. Systemic inflammation, reflected by CRP, was more pronounced in ESRD patients due to DN or GN , while IL-6 variations were not statistically significant across etiologies.
Table (4): Comparison between Baseline, cool and warmed according to CRP (n = 50)
Baseline
Cool
Warmed
Test of Sig.
p
CRP
Min. – Max.
4.0 – 24.0
0.95 – 15.90
2.0 – 29.0
Fr=75.360*
<0.001*
Mean ± SD.
17.36 ± 4.18
6.35 ± 4.28
15.90 ± 7.25
Median (IQR)
19.0 (15.0 – 20.0)
5.18 (2.76 – 10.0)
16.0 (10.0 – 23.0)
Sig.bet. Methods
p1<0.001*,p2=0.549,p3<0.001*
IL-6
7.10 – 11.0
4.30 – 8.0
7.0 – 11.10
F=431.948*
8.77 ± 0.94
5.56 ± 0.70
8.57 ± 0.99
8.70 (8.0 – 9.30)
5.50 (5.0 – 6.0)
8.35 (7.90 – 9.0)
p1<0.001*,p2=0.225,p3<0.001*
ESR
22.0 – 125.0
8.0 – 120.0
19.0 – 124.0
Fr=76.404*
78.22 ± 29.40
43.30 ± 29.53
78.20 ± 29.70
83.50 (60.0 – 100.0)
32.0 (23.0 – 58.0)
84.0 (55.0 – 100.0)
p1<0.001*,p2=0.424,p3<0.001*
IQR: Inter quartile range SD: Standard deviation
F: F test (ANOVA) with repeated measures, Sig. bet. periods was done using Post Hoc Test (adjusted Bonferroni)
Fr: Friedman test, Sig. bet. periods was done using Post Hoc Test (Dunn's)
p: p value for comparing between different method
p1: p value for comparing between Baseline and Cool
p2: p value for comparing between Baseline and Warmed
p3: p value for comparing between Cool and Warmed
*: Statistically significant at p ≤ 0.05
Comparison between cool and warmed according to dialysate with calculated urea reduction ratio (n = 50)
P
Before Sessions
83.0 – 161.0
97.0 – 188.0
Z=5.528*
110.9 ± 18.12
129.2 ± 21.70
108.5 (98.0 – 124.0)
125.5 (110.0 – 141.0)
After Sessions
26.0 – 68.0
32.0 – 87.0
Z=4.096*
38.70 ± 9.30
45.56 ± 10.85
38.0(31.0 – 43.0)
44.50(36.0 – 53.0)
Reduction (%)
47.69 – 72.48
44.23 – 71.79
t=0.391
0.697
65.21 ± 5.35
64.91 ± 4.54
66.67(62.79 – 68.55)
66.39(62.41 – 67.12)
IQR: Inter quartile range SD: Standard deviation t: Paired t-test
Z: Wilcoxon signed ranks test
p: p value for comparing between Cool and Warmed
Table (3):
Cooled dialysate significantly decreased CRP, IL-6, and ESR levels in maintenance HD patients without affecting dialysis adequacy. This simple, safe, and cost-effective approach may help attenuate chronic inflammation and improve treatment tolerance.
