Separate and combined effects of cold dialysis and intradialytic exercise on the thermoregulatory responses of hemodialysis patients: a randomized-cross-over study

Argyro A. Krase,Andreas D. Flouris,Christina Karatzaferi,Christoforos D. Giannaki,Ioannis Stefanidis,Giorgos K. Sakkas

doi:10.1186/s12882-020-02167-z

Argyro A. Krase, Andreas D. Flouris + Show 4 more

Open Access

https://doi.org/10.1186/s12882-020-02167-z

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Abstract

BackgroundThe separate and combined effects of intradialytic exercise training (IET) and cold dialysis (CD) on patient thermoregulation remain unknown. This study assessed the thermoregulatory responses of hemodialysis patients under four different hemodialysis protocols: a) one typical dialysis (TD) protocol (dialysate temperature at 37 °C), b) one cold dialysis (CD) protocol (dialysate temperature at 35 °C), c) one typical dialysis protocol which included a single exercise bout (TD + E), d) one cold dialysis protocol which included a single exercise bout (CD + E).MethodsTen hemodialysis patients (57.2 ± 14.9 years) participated in this randomized, cross-over study. Core and skin temperatures were measured using an ingestible telemetric pill and by four wireless iButtons attached on the skin, respectively. Body heat storage (S) calculated using the thermometric method proposed by Burton.ResultsThe TD and TD + E protocols were associated with increased S leading to moderate effect size increases in core body temperature (as high as 0.4 °C). The low temperature of the dialysate during the CD and the CD + E protocols prevented the rise in S and core temperature (p > 0.05), even during the period that IET took place.ConclusionsTD and IET are accompanied by a moderate level of hyperthermia, which can be offset by CD. We recommended that CD or with IET can prevent the excessive rise of S.Trial registrationClinical Trial Registry number: NCT03905551 (clinicaltrials.gov), DOR: 05/04/2019,

Highlights

The separate and combined effects of intradialytic exercise training (IET) and cold dialysis (CD) on patient thermoregulation remain unknown
Changes in Core body temperature (Tc) under four dialysis protocols The typical dialysis (TD) protocol resulted in an increase of core body temperature (TC) compared to the CD protocol (TD: 36.9 ± 0.1 °C; CD: 36.7 ± 0.2 °C)
The TC remained similar during the TD + E and the TD protocols (TD: 36.9 ± 0.1 °C; TD + E: 36.9 ± 0.2 °C) except during the period that exercise training took place, where a slight increase in TC was evident (TD: 36.9 ± 0.1 °C; TD + E: 37.0 ± 0.1 °C) resulting in a medium effect size observed at the end of exercise (Fig. 1)

Summary

Introduction

The separate and combined effects of intradialytic exercise training (IET) and cold dialysis (CD) on patient thermoregulation remain unknown. Body temperature rises during HD due to (i) heat transfer into the body via the heated dialysate, (ii) endogenous heat production through normal metabolic processes, and (iii) attenuated heat loss at the skin surface [3] The latter has been hypothesized to occur because cutaneous vessels are constricted during typical dialysis (TD; 37 °C dialysate temperature) due to loss of blood volume towards the extracorporeal circuit [4]. This leads to attenuated heat dissipation from the skin surface despite the fact that metabolic heat production remains relatively stable [5]. This increased heat storage (S) offsets the vasoconstrictive response to hypovolemia [7] and it is one of the responsible contributing factor which leading to the intradialytic hypotension causing patient discomfort and increased mortality [8, 9]

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