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Effect of cool vs. warm dialysate on toxin removal: rationale and study design

BACKGROUND: Cool dialysate is often recommended for prevention of intra-dialytic hypotensive episodes in maintenance hemodialysis (HD) patients. However, its effect on toxin removal is not studied. It is known that inter-compartmental resistance is the main barrier for toxin removal. Cool dialysate...

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Autores principales: Maheshwari, Vaibhav, Lau, Titus, Samavedham, Lakshminarayanan, Rangaiah, Gade P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381674/
https://www.ncbi.nlm.nih.gov/pubmed/25885180
http://dx.doi.org/10.1186/s12882-015-0017-5
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author Maheshwari, Vaibhav
Lau, Titus
Samavedham, Lakshminarayanan
Rangaiah, Gade P
author_facet Maheshwari, Vaibhav
Lau, Titus
Samavedham, Lakshminarayanan
Rangaiah, Gade P
author_sort Maheshwari, Vaibhav
collection PubMed
description BACKGROUND: Cool dialysate is often recommended for prevention of intra-dialytic hypotensive episodes in maintenance hemodialysis (HD) patients. However, its effect on toxin removal is not studied. It is known that inter-compartmental resistance is the main barrier for toxin removal. Cool dialysate can potentially increase this resistance by vasoconstriction and thus impair the toxin removal. The aim of this trial is to compare the toxin removal outcome associated with cool vs. warm dialysate. METHOD/DESIGN: This study is based on the hypothesis that dialysate temperature, a potential maneuver to maintain hemodynamic stability during HD, may influence inter-compartmental resistance and hence, toxin removal. Only stable HD patients will be recruited for this study. The quantum of removed toxins will be assessed by the total spent dialysate, which is a gold standard to quantify the efficacy of a single dialysis session. Collected samples will be analyzed for urea, creatinine, phosphate, β(2)-microglobulin, and uric acid. The study is a single center, self-controlled, randomized prospective clinical research where 20 study subjects will undergo 2 dialysis sessions: (a) cool dialysis with dialysate at 35.5°C, and (b) warm dialysis with dialysate at 37°C. Pre- and post-dialysis blood samples will be collected to quantify the dialysis adequacy and toxin reduction ratio. DISCUSSION: This is the first clinical research to investigate the effect of dialysate temperature on removal of both small and large-sized toxins. Successful completion of this research will provide important knowledge pertaining to dialysate temperature prescription. Results can also lead to the hypothesis that cool dialysate may help in by preventing intra-dialytic hypotensive episodes, but prolonged prescription of cool dialysate may lead to comorbidities associated with excess toxin accumulation. The new knowledge will encourage for personalized dialysate temperature profiling. TRIAL REGISTRATION: Clinicaltrials.gov Identifier - NCT02064153.
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spelling pubmed-43816742015-04-02 Effect of cool vs. warm dialysate on toxin removal: rationale and study design Maheshwari, Vaibhav Lau, Titus Samavedham, Lakshminarayanan Rangaiah, Gade P BMC Nephrol Study Protocol BACKGROUND: Cool dialysate is often recommended for prevention of intra-dialytic hypotensive episodes in maintenance hemodialysis (HD) patients. However, its effect on toxin removal is not studied. It is known that inter-compartmental resistance is the main barrier for toxin removal. Cool dialysate can potentially increase this resistance by vasoconstriction and thus impair the toxin removal. The aim of this trial is to compare the toxin removal outcome associated with cool vs. warm dialysate. METHOD/DESIGN: This study is based on the hypothesis that dialysate temperature, a potential maneuver to maintain hemodynamic stability during HD, may influence inter-compartmental resistance and hence, toxin removal. Only stable HD patients will be recruited for this study. The quantum of removed toxins will be assessed by the total spent dialysate, which is a gold standard to quantify the efficacy of a single dialysis session. Collected samples will be analyzed for urea, creatinine, phosphate, β(2)-microglobulin, and uric acid. The study is a single center, self-controlled, randomized prospective clinical research where 20 study subjects will undergo 2 dialysis sessions: (a) cool dialysis with dialysate at 35.5°C, and (b) warm dialysis with dialysate at 37°C. Pre- and post-dialysis blood samples will be collected to quantify the dialysis adequacy and toxin reduction ratio. DISCUSSION: This is the first clinical research to investigate the effect of dialysate temperature on removal of both small and large-sized toxins. Successful completion of this research will provide important knowledge pertaining to dialysate temperature prescription. Results can also lead to the hypothesis that cool dialysate may help in by preventing intra-dialytic hypotensive episodes, but prolonged prescription of cool dialysate may lead to comorbidities associated with excess toxin accumulation. The new knowledge will encourage for personalized dialysate temperature profiling. TRIAL REGISTRATION: Clinicaltrials.gov Identifier - NCT02064153. BioMed Central 2015-02-27 /pmc/articles/PMC4381674/ /pubmed/25885180 http://dx.doi.org/10.1186/s12882-015-0017-5 Text en © Maheshwari et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Study Protocol
Maheshwari, Vaibhav
Lau, Titus
Samavedham, Lakshminarayanan
Rangaiah, Gade P
Effect of cool vs. warm dialysate on toxin removal: rationale and study design
title Effect of cool vs. warm dialysate on toxin removal: rationale and study design
title_full Effect of cool vs. warm dialysate on toxin removal: rationale and study design
title_fullStr Effect of cool vs. warm dialysate on toxin removal: rationale and study design
title_full_unstemmed Effect of cool vs. warm dialysate on toxin removal: rationale and study design
title_short Effect of cool vs. warm dialysate on toxin removal: rationale and study design
title_sort effect of cool vs. warm dialysate on toxin removal: rationale and study design
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381674/
https://www.ncbi.nlm.nih.gov/pubmed/25885180
http://dx.doi.org/10.1186/s12882-015-0017-5
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