Stabilizing effects of cool dialysate temperature on hemodynamic parameters in diabetic patients undergoing hemodialysis.

To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3 +/- 7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 degrees C) temperature dialysate solution. During the study, all the dialysis conditions were maintained the same except cooling the dialysate from 37 degrees C to 35 degrees C. Hemodynamic parameters including SBP, DBP, and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic, and mean arterial pressure decreased significantly during standard temperature compared to cool dialysis. Maximum decrease of systolic, diastolic, and mean arterial pressure was observed during the third hour of dia-lysis and the magnitude of decrease was 18, 17, and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59 +/- 5 vs. 37 +/- 4, and 63 +/- 7 vs. 41 +/- 5, micromol/L respectively, P< 0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients.