Impact of Dialysate Temperature on Interdialytic and Intradialytic Hypotension, Serum Potassium, and Dialysis Adequacy Among Hemodialysis Patients

Abo Amasha, Merhan Mohamed Saleh; El Nahas, Mamdouh Radwan; Elmaghrabi, Hanzada Mohamed Helmi; Megahed, Ahmed Samir; Elkerdawy, Heidi Mohamed

doi:10.21608/muj.2025.350444.1199

Impact of Dialysate Temperature on Interdialytic and Intradialytic Hypotension, Serum Potassium, and Dialysis Adequacy Among Hemodialysis Patients

Articles in Press

Document Type : Letter to the Editor

Authors

¹ Nephrology resident at Ezbet Alborg central hospital ,Damietta,Egypt

² professor of endocrionlogy and diabetes ,internal medicine department, faculty of medicine, port said university, Egypt

³ Lecturer of nephrology, internal medicine department, faculty of medicine, portsaid university, Egypt

⁴ Lecturer of clinical hematology,internal medicine department, faculty of medicine,portsaid university,Egypt

10.21608/muj.2025.350444.1199

Abstract

Abstract
Background: Intradialytic hypotension (IDH) is a significant complication of hemodialysis, affecting patient outcomes and quality of life. Dialysate cooling has been proposed to mitigate IDH by stabilizing blood pressure and improving dialysis adequacy. This study aimed to evaluate the effects of cooling dialysate to 36°C and 35°C on dialysis adequacy, potassium levels, and intradialytic blood pressure stability.
Methods: This prospective single-center crossover study included 60 hemodialysis patients treated at Ezbet Al-Borg Dialysis Center, Damietta, Egypt, from January to June 2024. Participants underwent three study phases: a standard phase with a dialysate temperature of 37°C, followed by two cooling phases at 36°C and 35°C. Data collected included blood pressure measurements, dialysis adequacy parameters (Kt/V), and serum potassium levels. Statistical analyses utilized repeated measures ANOVA and Pearson correlation.
Results: Cooling dialysate to 35°C significantly improved Kt/V values (1.22 ± 0.2) compared to 37°C (1.14 ± 0.2, p = 0.004). In contrast, cooling to 36°C showed no significant effect. Serum potassium levels remained stable across phases. Intradialytic systolic and diastolic blood pressures were significantly higher during cooling phases, particularly at 35°C (p < 0.001). Positive correlations were observed between Kt/V and intradialytic and interdialytic blood pressures (p < 0.001).
Conclusion: Cooling dialysate to 35°C significantly improves dialysis adequacy and stabilizes intradialytic blood pressure without adverse effects on potassium levels. Personalized cooling protocols may optimize dialysis outcomes.

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