Largest trial ever done in hemodialysis care examines optimal dialysis temperature
More than 15,000 patients participated across 84 hemodialysis centres
Published in the Lancet, findings from a large clinical trial through Lawson Health Research Institute (Lawson), ICES Western and Western University suggest that lowering dialysis temperatures does not lead to improved patient outcomes, despite previous studies suggesting otherwise.
The standard temperature for dialysis treatments is approximately 36.5 degrees Celsius, which is similar to a human’s body temperature. But over the past several years, there have been small studies suggesting that cooler dialysis temperatures could reduce the risk of cardiovascular-related deaths and hospitalizations and better maintain blood pressures during hemodialysis treatments.
“There have been studies looking at whether a lower dialysis temperature would result in better outcomes,” says Dr. Amit Garg, Lawson scientist, site director for ICES Western and associate dean of clinical research at Western’s Schulich School of Medicine & Dentistry. “The studies have been limited, especially in numbers, yet the practice of lowering the dialysis temperature has become a practice growing in popularity. Some institutions have even made this a centre-wide policy for all hemodialysis patients.”
Over the course of four years, the research team examined outcomes of both standard and cooler dialysis treatments in more than 15,000 patients. This was done across 84 of 97 hemodialysis centres in Ontario, and in terms of the number of patients, it the largest hemodialysis trial ever published worldwide. Ten of the centres were those operated through London Health Sciences Centre (LHSC).
“We wanted to determine if lowering the dialysis temperature would help people live longer and healthier,” explains Dr. Garg, who is also a nephrologist at LHSC. “We also measured symptoms and how people felt on the dialysis. We set out to collect high-quality evidence to make sure we are doing the right thing for patients.”
The research team examined linked healthcare data sets from ICES. The trial period included a total of 4.3 million hemodialysis treatments. Patients were randomized to receive dialysis with either the standard temperature or a lowered dialysis temperature of 0.5 degrees Celsius to 0.9 degrees Celsius below each patient’s measured pre-dialysis body temperature, with a lowest recommended temperature of 35.5 degrees Celsius.
“We did not see any benefits to patients who had the lowered temperature with no improvements to cardiovascular health. Some patients experienced discomfort from the lower dialysis temperature,” says Dr. Garg. “The results suggest we should not be adopting lower dialysis temperatures, as a centre-wide policy, and its utility in select patient care warrants scrutiny.”
The findings were presented by Dr. Garg at the American Society of Nephrology conference in Orlando, Florida on Friday Nov 4th @ 11:45 am EST.
About Lawson Health Research Institute: Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in healthcare. As the research institute of London Health Sciences Centre and St. Joseph’s Healthcare London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world. To learn more, visit www.lawsonresearch.ca.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
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