Nephrol Dial Transplant (1999) 14: 2196-2200
© 1999 European Renal Association-European Dialysis and Transplant Association
Technical Report
Thermal energy balance and body temperature: comparison between isolated ultrafiltration and haemodialysis at different dialysate temperatures
Department of Internal Medicine and Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
Correspondence and offprint requests to: F. M. van der Sande, MD, Department of Internal Medicine and Nephrology, University Hospital Maastricht, P. Debeyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Abstract
Background. Haemodynamic stability is better maintained during isolated ultrafiltration (i-UF) than during combined ultrafiltration/haemodialysis (UF+HD). This difference might be explained by differences in thermal energy balances. In this study we compared the thermal energy balance of i-UF with UF+HD at different dialysate temperatures (Td) and determined the Td at which the thermal energy balance during UF+HD is similar to the thermal energy balance during i-UF.
Methods. In the first part of the study, 10 chronic haemodialysis patients were compared during three different treatment sessions, i-UF, UF+HD at Td of 35.5°C and UF+HD at Td of 37.5°C. The second part of the study consisted of one session of 1 h of UF+HD (UF+HD ET-set) with a pre-set energy transfer (ET) at the same level of ET found for that particular patient during i-UF in the first part of the study.
Results. First part of the study: body temperature (BT) decreased significantly during i-UF (-0.25±0.25°C, P<0.05) and UF+HD 35.5°C (-0.24±0.18°C, P<0.05) and increased significantly during UF+HD 37.5°C (+0.18±0.19°C, P<0.05). The differences between the change in BT during UF+HD 37.5°C compared with the other treatments were significant (P<0.05). ET gave a significantly more negative value during i-UF (-30.8±3.1 W, P<0.05) than during UF+HD 35.5°C (-23.6±4.1 W, P<0.05). A slightly positive ET was found during UF+HD 37.5°C (+0.4±4.7 W, P=not significant). Second part of the study: there was a slight, but not significant, decrease in BT during UF+HD ET-set (-0.17±0.26°C). The changes in BT did not differ significantly between i-UF and UF+HD ET-set. After 1 h of UF+HD ET-set, the mean Td was 34.75°C (34.0–36.0°C). The correlation between pre-dialysis BT and Td during UF+HD ET-set was significant (r=0.764, P<0.05).
Conclusion. ET gives a more negative value during i-UF than during UF+HD 35.5°C and than during UF+HD 37.5°C. To obtain the same thermal ET during UF+HD as that achieved during i-UF, a mean Td of 34.75°C is needed, depending on the pre-dialytic BT of the patient. The results of this study may be of relevance in relation to future clinical investigations which can elucidate whether differences in vascular response between i-UF and UF+HD are only related to differences in thermal balance.
Keywords: dialysate temperature; energy transfer; haemodialysis; ultrafiltration
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