NDT Advance Access originally published online on July 5, 2005
Nephrology Dialysis Transplantation 2005 20(9):1784-1789; doi:10.1093/ndt/gfh901
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Editorial Comment
Why thermosensing? A primer on thermoregulation
1 Fresenius Medical Care, Bad Homburg v. d. H., Heinrich-Heine University, Düsseldorf, Germany and 2 Ginsterweg 8, 61169 Friedberg, Germany
Correspondence and offprint requests to: Jutta Passlick-Deetjen, MD, PhD, Fresenius Medical Care, 61346 Bad Homburg v. d. H., Germany. Email: Jutta.Passlick-Deetjen@fmc-ag.com
Keywords: dialysate temperature; dialysis-induced hypotension; haemodialysis; haemodialyis patient; thermoregulation; thermosensing
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Introduction |
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Symptomatic hypotension is a frequent complication during haemodialysis treatment sessions. One of the reasons is rapid blood volume reduction with inadequate vasoconstriction. Furthermore, heat accumulation during dialysis occurs and leads to decreased peripheral resistance and thus decreased venous return. As a consequence, cooler than the usual dialysate temperatures were used and showed an advantage for cardiovascular stability during haemodialysis [1–12]. This practice has not been applied in clinical routine up to now, as patients dependent on their actual temperature suffered from shivering. If future practice would take the optimal individualized dialysate temperature of patients into account, the quality of dialysis treatment could be further improved. The question, however, is which is the optimal dialysate temperature, and how can it be achieved? In order to answer this question in more detail some principles of thermoregulation will be discussed.
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Principles of thermoregulation |
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Humans are homeothermic organisms and body temperature regulation is tight as
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General principles of heat gain and heat loss of the body |
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Control of skin blood flow |
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Individual differences in temperature regulation |
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The challenge of thermoregulation in haemodialysis patients |
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Body temperature in healthy subjects and in haemodialysis patients
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What is the best method for estimating body temperature in order to adapt and individualize dialysate temperature? |
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Influence of the extracorporeal circuit on body temperature |
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Why thermosensing? |
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Thermosensing during dialysis—optimal conditions for cardiovascular stability |
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Conclusion |
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