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London, Ont. researchers preform largest dialysis temperature trial for kidney patients

Dr. Amit Garg, Lawson scientist, site director for ICES Western and associate dean of clinical research at Western’s Schulich School of Medicine and Dentistry. Lawson Health Research Institute

Researchers in London, Ont., are working to provide some clarity for kidney disease patients on what the optimal temperature is for dialysis treatment, despite previous studies suggesting otherwise.

A new study published in the Lancet — an independent and international weekly general medical journal founded in 1823 — shared findings from a large clinical trial through Lawson Health Research Institute, ICES Western and Western University that found that lowering dialysis temperatures does not in fact lead to improved patient outcomes.

“The historical reason for this is unclear but likely represents what was considered the average body temperature of most patients,” said Dr. Amit Garg, Lawson scientist, site director for ICES Western and associate dean of clinical research at Western’s Schulich School of Medicine and Dentistry.

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According to the study, the standard temperature for dialysis treatments is approximately 36.5 C, similar to the human body temperature.

However, over the past several years, “there have been smaller studies suggesting that cooler dialysis temperatures could reduce the risk of cardiovascular-related deaths and hospitalizations,” and also better maintain blood pressures during hemodialysis treatments, the study explained.

“People come to a dialysis unit typically three times a week for treatment for three and a half to four and a half hours, and they’re about 650 people who do that in our London Health Sciences Centre (LHSC) across 11 hemodialysis units, about 8,000 Ontarians, and about two million people worldwide who require these treatments approximately three times a week to sustain life,” Garg explained.

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He said those smaller 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.”

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For about four years, the local research team examined both standard and cooler dialysis treatments in more than 15,000 patients across 84 out of 97 hemodialysis centres in the province to see which resulted in more positive outcomes. Ten of those were operated through LHSC.

Participating patients were “randomized to receive dialysis” either with the standard temperature or a lowered temperature of 0.5 C to 0.9 C, all below “each patient’s measured pre-dialysis body temperature.”

The trial period included a total of 4.3 million forms of this treatment and, according to the study, this was the largest hemodialysis trial ever published worldwide.

“We found no difference between the two groups in the rates of cardiovascular mortality or hospital admission for heart attack, stroke or heart failure,” Garg said. “We found even no difference in the drop in systolic blood pressure that occurs during dialysis treatment.”

Additionally, patients subjected to the personalized cooler dialysate group reported being uncomfortably cold while on dialysis.

“So, on this basis, there’s new data showing that a lack of cardiovascular benefit, compounded by the fact that it causes some patient discomfort, provides no justification to adopt cooler dialysis, as a centre-wide policy has occurred in some centres in Ontario and even nationally,” Garg explained.

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Garg presented these findings at the American Society of Nephrology conference in Orlando, Fla., earlier this month, adding that “this trial was conducted at a fraction of the cost of a traditional trial.”

“We’re quite excited about it because this is a new, innovative way we can generate high-quality information efficiently, I’d say faster, cheaper (and) better than we would in the usual manner,” he said.

Currently, one in 10 Canadians is living with kidney disease.

“Unfortunately not all of those who have kidney disease end up reaching dialysis, but we also tried to prevent kidney failure as much as possible,” Garg said.

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