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      Cold dialysis and its impact on renal patients’ health: An evidence-based mini review

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          Abstract

          Chronic renal disease is associated with advanced age, diabetes, hypertension, obesity, musculoskeletal problems and cardiovascular disease, the latter being the main cause of mortality in patients receiving haemodialysis (HD). Cooled dialysate (35 °C-36 °C) is recently employed to reduce the incidence of intradialytic hypotension in patients on chronic HD. The studies to date that have evaluated cooled dialysate are limited, however, data suggest that cooled dialysate improves hemodynamic tolerability of dialysis, minimizes hypotension and exerts a protective effect over major organs including the heart and brain. The current evidence-based review is dealing with the protective effect of cold dialysis and the benefits of it in aspects affecting patients’ quality of care and life. There is evidence to suggest that cold dialysis can reduce cardiovascular mortality. However, large multicentre randomized clinical trials are urgently needed to provide further supporting evidence in order to incorporate cold dialysis in routine clinical practice.

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          Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients.

          Tatsuya Shoji, M Fujii, Yoshiharu Tsubakihara … (2004)
          The relationship between blood pressure (BP) and mortality in hemodialysis patients has remained controversial. Some studies suggested that a lower pre- or postdialysis BP was associated with excess mortality, while others showed poorer outcome in patients with uncontrolled hypertension. We conducted a multicenter prospective cohort study to evaluate the impact of hemodialysis-associated hypotension on mortality. We recruited 1244 patients (685 males; mean age, 60 +/- 13 years) who underwent hemodialysis in 28 units during the two-year study period beginning in December 1999. Pre-, intra-, and postdialysis BP, and BP upon standing soon after hemodialysis, were measured in all patients at entry. Logistic regression analysis was used to assess the effect on mortality of pre-, intra-, and postdialysis BP, a fall in BP during hemodialysis, and a fall in BP upon standing soon after hemodialysis. During the study period, 149 patients died. Logistic models identified the lowest intradialysis systolic blood pressure (SBP) and degree of fall in SBP upon standing soon after hemodialysis as significant factors affecting mortality, but not pre- or postdialysis SBP and diastolic BP. The adjusted odds ratio for death was 0.79 (95% CI 0.64-0.98) when the lowest intradialysis SBP was analyzed in increments of 20 mm Hg, and was 0.82 (95% CI 0.67-0.98) when the fall in SBP upon standing soon after hemodialysis was analyzed in increments of 10 mm Hg. These results suggest that intradialysis hypotension and orthostatic hypotension after hemodialysis are significant and independent factors affecting mortality in hemodialysis patients.
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            Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients.

            David T Gilbertson, Susan J. Snyder, Eric D Weinhandl … (2010)
            Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients.
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              Recent advances in the prevention and management of intradialytic hypotension.

              Raymond F. Palmer, W L Henrich (2007)
              Intradialytic hypotension continues to play a significant role in the morbidity and in some cases the mortality associated with maintenance hemodialysis. Greater precision in the determination of dry weight using bioimpedance technology and biofeedback systems designed to prevent rapid fluctuations in blood volume have recently been shown to decrease the frequency of this complication. Pharmacologic strategies designed to maintain peripheral vascular resistance in patients with insufficient release of endogenous vasoconstrictors continue to be explored. The sudden development of intradialytic hypotension may respond to specific antagonists to hypotensive mediators.
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Nephrol
                Journal ID (publisher-id): WJN
                Title: World Journal of Nephrology
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 2220-6124
                Publication date (Print): 6 May 2017
                Publication date (Electronic): 6 May 2017
                Volume: 6
                Issue: 3
                Pages: 119-122
                Affiliations
                Giorgos K Sakkas, Christina Karatzaferi, Faculty of Sport and Health Sciences, University of St Mark and St John, Plymouth PL6 8BH, United Kingdom
                Giorgos K Sakkas, Christina Karatzaferi, School of PE and Sport Science, University of Thessaly, GR42100 Trikala, Greece
                Argiro A Krase, School of PE and Sport Science, University of Thessaly, GR42100 Trikala, Greece
                Christoforos D Giannaki, Department of Life and Health Sciences, University of Nicosia, CY1700 Nicosia, Cyprus
                Author notes

                Author contributions: Sakkas GK and Karatzaferi C substantial contributions to conception and design of the review, acquisition of literature data, analysis and interpretation of data, drafting the article, making critical revisions related to important intellectual content of the manuscript, and final approval of the version of the article to be published; Krase AA and Giannaki CD substantial contributions to conception and design of the study, making critical revisions related to important intellectual content of the manuscript, final approval of the version of the article to be published.

                Correspondence to: Dr. Giorgos K Sakkas, Faculty of Sport and Health Sciences, University of St Mark and St John, Derriford Rd, Plymouth PL6 8BH, United Kingdom. gsakkas@ 123456marjon.ac.uk

                Telephone: +44-1752-636837

                Article
                Other ID: jWJN.v6.i3.pg119
                DOI: 10.5527/wjn.v6.i3.119
                PMC ID: 5424433
                PubMed ID: 28540201
                SO-VID: 7db22cf9-17b5-426b-bc7a-b1dc72635272
                Copyright © ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 28 January 2017
                Date revision received : 1 April 2017
                Date accepted : 23 April 2017
                Categories
                Subject: Minireviews

                Keywords: mortality,cardiovascular diseases,fatigue,hypotension,shivering,renal failure
                Data availability:
                Keywords: mortality, cardiovascular diseases, fatigue, hypotension, shivering, renal failure

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