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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+J+Am+Soc+Nephrol
2016 ; 11
(3
): 442-57
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Effect of Lowering the Dialysate Temperature in Chronic Hemodialysis: A
Systematic Review and Meta-Analysis
#MMPMID26712807
Mustafa RA
; Bdair F
; Akl EA
; Garg AX
; Thiessen-Philbrook H
; Salameh H
; Kisra S
; Nesrallah G
; Al-Jaishi A
; Patel P
; Patel P
; Mustafa AA
; Schünemann HJ
Clin J Am Soc Nephrol
2016[Mar]; 11
(3
): 442-57
PMID26712807
show ga
BACKGROUND AND OBJECTIVES: Lowering the dialysate temperature may improve
outcomes for patients undergoing chronic hemodialysis. We reviewed the reported
benefits and harms of lower temperature dialysis. DESIGN, SETTING, PARTICIPANTS,
& MEASUREMENTS: We searched the Cochrane Central Register, OVID MEDLINE, EMBASE,
and Pubmed until April 15, 2015. We reviewed the reference lists of relevant
reviews, registered trials, and relevant conference proceedings. We included all
randomized, controlled trials that evaluated the effect of reduced temperature
dialysis versus standard temperature dialysis in adult patients receiving chronic
hemodialysis. We followed the Grading of Recommendations Assessment, Development
and Evaluation approach to assess confidence in the estimates of effect (i.e.,
the quality of evidence). We conducted meta-analyses using random effects models.
RESULTS: Twenty-six trials were included, consisting of a total of 484 patients.
Compared with standard temperature dialysis, reduced temperature dialysis
significantly reduced the rate of intradialytic hypotension by 70% (95%
confidence interval, 49% to 89%) and significantly increased intradialytic mean
arterial pressure by 12 mmHg (95% confidence interval, 8 to 16 mmHg). Symptoms of
discomfort occurred 2.95 (95% confidence interval, 0.88 to 9.82) times more often
with reduced temperature compared with standard temperature dialysis. The effect
on dialysis adequacy was not significantly different, with a Kt/V mean difference
of -0.05 (95% confidence interval, -0.09 to 0.01). Small sample sizes, loss to
follow-up, and a lack of appropriate blinding in some trials reduced confidence
in the estimates of effect. None of the trials reported long-term outcomes.
CONCLUSIONS: In patients receiving chronic hemodialysis, reduced temperature
dialysis may reduce the rate of intradialytic hypotension and increase
intradialytic mean arterial pressure. High-quality, large, multicenter,
randomized trials are needed to determine whether reduced temperature dialysis
affects patient mortality and major adverse cardiovascular events.
|*Cold Temperature/adverse effects
[MESH]
|Arterial Pressure
[MESH]
|Chi-Square Distribution
[MESH]
|Hemodialysis Solutions/adverse effects/*therapeutic use
[MESH]
|Humans
[MESH]
|Hypertension/etiology/physiopathology
[MESH]
|Hypotension/etiology/physiopathology/prevention & control
[MESH]