Azar Ahmad Taher
Biomedical Engineering Department, Misr University for Science and Technology, Egypt.
Saudi J Kidney Dis Transpl. 2009 Jul;20(4):596-603.
Cooling the dialysate below 36.5 degrees C is an important factor that contributes to hemodynamic stability in patients during hemodialysis (HD). In this study, the effect of dialysate temperature on hemodynamic stability, patients' perception of dialysis discomfort and post dialysis fatigue were assessed in a group of patients on HD. A total of 50 patients, all of whom were on 3-times-per-week dialysis regimen, were studied. Patients were assessed during six dialysis sessions; in three sessions, the dialysate temperature was normal (37 degrees C) and in three other sessions, the dialysate temperature was low (35 degrees C). Specific scale questionnaires were used in each dialysis session, to evaluate the symptoms during the dialysis procedure as well as post-dialysis fatigue, and respective scores were noted. The results showed that usage of low dialysate temperature was associated with the following: higher post dialysis systolic blood pressure (P< 0.05) and lower post dialysis heart rate (P< 0.01), with similar ultrafiltration rates, better intra-dialysis symptoms score and post-dialysis fatigue scores (P< 0.001, and P < 0.001, respectively), shorter post-dialysis fatigue period (P< 0.001) as well as higher urea removal (P< 00001) and Kt/V (P< 0.0001). Patients' perceptions were measured by a questionnaire, which showed that 76% of them felt more energetic after dialysis with cool dialysate and requested to be always dialyzed with cool dialysate. Low temperature dialysate is particularly beneficial for highly symptomatic patients, improves tolerance to dialysis in hypotensive patients and helps increase ultrafiltration while maintaining hemodynamic stability during and after dialysis.
将透析液温度降至36.5摄氏度以下是血液透析（HD）期间有助于患者血流动力学稳定的一个重要因素。在本研究中，对一组接受HD治疗的患者评估了透析液温度对血流动力学稳定性、患者对透析不适的感知以及透析后疲劳的影响。共研究了50名患者，他们均采用每周透析3次的方案。在6次透析过程中对患者进行评估；其中3次透析时透析液温度正常（37摄氏度），另外3次透析时透析液温度较低（35摄氏度）。每次透析过程中使用特定的量表问卷来评估透析过程中的症状以及透析后疲劳情况，并记录相应得分。结果显示，使用低温透析液与以下情况相关：透析后收缩压较高（P<0.05），透析后心率较低（P<0.01），超滤率相似，透析期间症状评分和透析后疲劳评分更好（分别为P<0.001和P<0.001），透析后疲劳期较短（P<0.001），以及尿素清除率较高（P<0.00001）和Kt/V较高（P<0.0001）。通过问卷调查来衡量患者的感受，结果显示76%的患者在使用低温透析液透析后感觉精力更充沛，并要求始终使用低温透析液进行透析。低温透析液对症状严重的患者特别有益，可提高低血压患者对透析的耐受性，并有助于在透析期间和透析后保持血流动力学稳定的同时增加超滤量。
