November 9, 2022
2 thousand trains
Garg AX, et al. FR-OR66. Presented at: ASN Kidney Week; Nov. 3-6, 2022; Orlando (hybrid meeting).
Garg says he was employed by the London Health Sciences Center and received research funding from Astellas and Baxter.
ORLANDO — Because of the limited benefit and high likelihood of patient discomfort, an ASN Kidney Week dialysis center presenter recommends not using dialysis methods for center cooling.
“Adopting dialysis coolers as a center-wide policy, as is being done in some centers, facilitates implementation, tends to benefit the majority of patients where hemodialysis CVD is common and meets the eligibility criteria [of] previous attempts,” Amit X. Garg, doctor, doctor, from the London Health Sciences Centre, said in a presentation. He added: “The disadvantage of a fixed-temperature dialyzer cooler for all patients is that some people shiver and feel uncomfortably cold, especially when their pre-dialysis body temperature is higher than the set dialysis temperature.”
In a pragmatic, two-arm, parallel-group, registry-based, open-label, cluster-randomized trial (MyTemp), researchers randomized 84 centers to use either a customized cryodialysis device set 0.5°C to 0.9°C below each patient’s measured body temperature for dialysis, with a minimum recommended dialysis temperature of 35.5°C, or standard dialysis water temperature set at 36.5°C for all patients and treatments. A total of 15,413 patients received care during the study.
During the study period from April 2017 to March 2021, researchers considered the primary outcome to be a composite of cardiovascular-related death or hospitalization for myocardial infarction, ischemic stroke, or heart failure.
Researchers identified 35.8°C as the average dialysate temperature in the colder dialysis group compared to 36.4°C in the standard temperature group. Overall, patients were more likely to report feeling uncomfortably cold during dialysis in the cooler dialysate group.
The primary outcome was observed in 21.4% of the group receiving dialysis water cooling vs. 22.4% of the standard temperature group. However, there is a trend everywhere in the middle of personal cooler dialysis vs. normal temperature dialysis did not significantly reduce the risk of major cardiovascular events.
In addition, the mean reduction in systolic blood pressure during dialysis was 26.6 mmHg vs. 27.1 mmHg, respectively.
“For a nephrologist, like myself, who currently uses cooler dialysis for individual patients, the test results give me an opportunity to reflect on the practice. If I prescribe cryodialysis drugs for certain patients, such as those with intolerable hypertension on dialysis, I plan to do it better and monitor how well it is tolerated. I would certainly feel more confident about its use in such patients in future well-conducted, multicenter trials with limited eligibility, so the benefits outweigh the risks. Ultimately for researchers, the experience we developed with innovative design elements in MyTemp could help optimize future lifestyles and test interventions to improve kidney care.”