Minimizing Myocardial Ischemic Injury by Cool Dialysate in Maintenance Hemodialysis Patients: A Randomized Controlled Trial

Abstract

Background: Emerging evidence supports a cardiovascular protective role of Cooled Dialysis (CD) in incident Hemodialysis (HD) patients. Whether this benefit can be extended to maintenance HD patients remains to be established. Objective: The aim of the present study was to assess the impact of CD by lowering Dialysate temperature (dt) 0.5oC below Core Body Temperature (CBT), on minimizing myocardial ischemia in maintenance HD patients (>1 year on HD). Patients and Methods: from March 2019 to January 2021, we randomized one hundred maintenance HD patients to receive either Cooled Dialysis (dt - 0.5oC below CBT, intervention) or Standard Dialysis (dt= CBT, control) for 12 months. Over the study period, serial measurements of ECG, echocardiography, and myocardial enzymes (CK-MB and Troponin-T) were performed for the whole study population as surrogates for myocardial ischemic injury. Results: By the end of 12-months, compared to Standard Dialysis (ST) patients, Cooled Dialysis (CD) patients had overall less incidence of new myocardial ischemia (composite surrogate outcomes: ECG, Echo and CK-MB) (p=0.032). In logistic regression analysis, CD was found to be independently protective against myocardial ischemia (OR 0.54, p-value 0.033, CI: 0.3-0.95). Conclusion: In maintenance HD patients, Cooled Dialysis might help decrease myocardial ischemia with a reasonable safety profile. Further studies are warranted to explore these findings.