Abstract:
:The rationale of temperature control during hemodialysis (HD) is to prevent heat accumulation, which increases body temperature and enhances hypotensive susceptibility. Treatments where thermal energy is neither delivered nor removed from the patient through the extracorporeal circulation (so-called extracorporeal thermoneutral treatments) lead to a marked increase in body temperature and to considerable heat accumulation during HD. Since this accumulation of heat cannot be explained by increased heat production, it must be related to reduced heat dissipation through the body surface. Peripheral vasoconstriction, and cutaneous vasoconstriction in particular, compensating for the ultrafiltration-induced decrease in blood volume is considered an important component in this setting. Therefore, to maintain temperature homeostasis, thermal energy has to be cleared from the patient by the extracorporeal system because cutaneous clearance of thermal energy is compromised intradialytically. The focus on dialysate temperature alone does not properly address the problem of controlled extracorporeal heat removal because dialysate temperature is only one of the variables involved in that process. These difficulties can be addressed by changing from the control of dialysate temperature to control of body temperature. Control of body temperature and temperature homeostasis is achievable by the physiologic feedback control system realized in the temperature control mode (T-mode) of the blood temperature monitor (BTM). The delivery of isothermic dialysis, that is, dialysis where body temperature is controlled to remain constant during the treatment, has impressively improved hemodynamic stability in hypotension prone patients.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Schneditz D,Ronco C,Levin Ndoi
10.1046/j.1525-139x.2003.16103.xsubject
Has Abstractpub_date
2003-11-01 00:00:00pages
477-82issue
6eissn
0894-0959issn
1525-139Xpii
16103journal_volume
16pub_type
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journal_title:Seminars in dialysis
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