{"id":1752,"date":"2022-11-04T00:00:00","date_gmt":"2022-11-04T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/personalised-cooler-dialysate-for-patients-receiving-maintenance-haemodialysis-mytemp-a-pragmatic-cluster-randomised-trial\/"},"modified":"2023-06-14T19:46:31","modified_gmt":"2023-06-14T23:46:31","slug":"personalised-cooler-dialysate-for-patients-receiving-maintenance-haemodialysis-mytemp-a-pragmatic-cluster-randomised-trial","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/personalised-cooler-dialysate-for-patients-receiving-maintenance-haemodialysis-mytemp-a-pragmatic-cluster-randomised-trial\/","title":{"rendered":"Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic cluster-randomised trial"},"content":{"rendered":"

Background<\/strong> — Conventionally, healthcare centres have provided maintenance haemodialysis using a 15 standard dialysate temperature (e.g., 36·5°C) for all patients. Many centres now use cooler dialysate (e.g. 36°C or lower) for potential cardiovascular benefits. The MyTEMP trial assessed whether personalised cooler dialysate, implemented as centre-wide policy, reduced the risk of cardiovascular-related deaths and hospitalisations compared with standard-temperature dialysate.<\/p>\n

Methods<\/strong> — MyTEMP was a pragmatic, two-arm, parallel-group, registry-based, open-label, cluster-randomised, superiority trial done at 84 of Ontario’s 97 haemodialysis centres (Canada). Using covariate-constrained randomisation, we allocated 84 centres (1:1) to use either (1) personalised cooler dialysate (nurses set the dialysate temperature 0·5–0·9°C below each patient’s measured pre-dialysis body temperature, with a lowest recommended dialysate temperature of 35·5°C), or (2) standard-temperature dialysate (36·5°C for all patients and treatments). The primary composite outcome was cardiovascular-related death or hospital admission with myocardial infarction, ischaemic stroke, or congestive heart failure during the four-year trial period. The key secondary outcome was the mean  drop in intradialytic systolic blood pressure. Analysis was by intention to treat. The study is registered at ClinicalTrials.gov, NCT02628366.<\/p>\n

Findings<\/strong> — Between April 3, 2017 and March 31, 2021, the 84 centres provided outpatient maintenance haemodialysis to 15 413 patients (~4·3 million haemodialysis treatments). The mean dialysate temperature was 35·8°C in the cooler dialysate group versus 36·4°C in the standard-temperature group. The primary outcome occurred in 1711 of 8000 patients (21·4%) in the cooler dialysate group versus 1658 of 7413 patients (22·4%) in the standard-temperature group; adjusted hazard ratio, 1·00 (96% CI, 34 0·89 to 1·11; p=0·93). The mean drop in intradialytic systolic blood pressure was 26·6 mm Hg versus 27·1 35 mm Hg, respectively; mean difference, -0·5 mm Hg; 99% CI -1·4 to 0·4 (p=0·14).<\/p>\n

Interpretation<\/strong> — Centre-wide delivery of personalised cooler dialysate versus standard-temperature dialysate did not significantly reduce the risk of major cardiovascular events. The rising popularity of cooler dialysate is called into question by this study.<\/p>\n","protected":false},"excerpt":{"rendered":"

Background — Conventionally, healthcare centres have provided maintenance haemodialysis using a 15 standard dialysate temperature (e.g., 36·5°C) for all patients. Many centres now use cooler dialysate (e.g. 36°C or lower) for potential cardiovascular benefits. The MyTEMP trial assessed whether personalised cooler dialysate, implemented as centre-wide policy, reduced the risk of cardiovascular-related deaths and hospitalisations compared […]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-1752","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"The MyTEMP writing committee. Lancet<\/em>. 2022; 400(1034):1693-703. Epub 2022 Nov 4.","source_url":"https:\/\/doi.org\/10.1016\/S0140-6736(22)01805-0","ices_scientist":[1242,1208,1135,1138,1123],"site":[6739],"research_program":[6743],"news_release":[7399],"journal_article":[],"atlas":[],"research_report":[],"infographic":[9277],"video":[15719],"downloads":null,"links":null,"sitecore_item_id":"8C9B6AFB-5268-423B-A9F4-81DFAE04C0E7","sitecore_item_name":"Personalised-cooler-dialysate-for-patients-receiving-maintenance-haemodialysis-MyTEMP","sitecore_field_values":"{\n \"Title\": \"Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic cluster-randomised trial\",\n \"Short title\": \"Personalised cooler dialysate for\",\n \"Summary\": \"This study found that centre-wide delivery of personalised cooler dialysate versus standard-temperature dialysate did not significantly reduce the risk of major cardiovascular events.\",\n \"Citation\": \"

The MyTEMP writing committee. Lancet<\/em>. 2022; 400(1034):1693-703. Epub 2022 Nov 4. DOI: https:\/\/doi.org\/10.1016\/S0140-6736(22)01805-0<\/a><\/p>\",\n \"Abstract\": \"

Background<\/strong> — Conventionally, healthcare centres have provided maintenance haemodialysis using a 15 standard dialysate temperature (e.g., 36·5°C) for all patients. Many centres now use cooler dialysate (e.g. 36°C or lower) for potential cardiovascular benefits. The MyTEMP trial assessed whether personalised cooler dialysate, implemented as centre-wide policy, reduced the risk of cardiovascular-related deaths and hospitalisations compared with standard-temperature dialysate.<\/p>n

Methods<\/strong> — MyTEMP was a pragmatic, two-arm, parallel-group, registry-based, open-label, cluster-randomised, superiority trial done at 84 of Ontario’s 97 haemodialysis centres (Canada). Using covariate-constrained randomisation, we allocated 84 centres (1:1) to use either (1) personalised cooler dialysate (nurses set the dialysate temperature 0·5–0·9°C below each patient’s measured pre-dialysis body temperature, with a lowest recommended dialysate temperature of 35·5°C), or (2) standard-temperature dialysate (36·5°C for all patients and treatments). The primary composite outcome was cardiovascular-related death or hospital admission with myocardial infarction, ischaemic stroke, or congestive heart failure during the four-year trial period. The key secondary outcome was the mean  drop in intradialytic systolic blood pressure. Analysis was by intention to treat. The study is registered at ClinicalTrials.gov, NCT02628366.<\/p>n

Findings<\/strong> — Between April 3, 2017 and March 31, 2021, the 84 centres provided outpatient maintenance haemodialysis to 15 413 patients (~4·3 million haemodialysis treatments). The mean dialysate temperature was 35·8°C in the cooler dialysate group versus 36·4°C in the standard-temperature group. The primary outcome occurred in 1711 of 8000 patients (21·4%) in the cooler dialysate group versus 1658 of 7413 patients (22·4%) in the standard-temperature group; adjusted hazard ratio, 1·00 (96% CI, 34 0·89 to 1·11; p=0·93). The mean drop in intradialytic systolic blood pressure was 26·6 mm Hg versus 27·1 35 mm Hg, respectively; mean difference, -0·5 mm Hg; 99% CI -1·4 to 0·4 (p=0·14).<\/p>n

Interpretation<\/strong> — Centre-wide delivery of personalised cooler dialysate versus standard-temperature dialysate did not significantly reduce the risk of major cardiovascular events. 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